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CHAIN OF CUSTODY 1 LABORATORY ANALYSIS REQUEST FORM <br /> SHAW Environmental&Infrastructure,Inc Purchase Order 3648 for 2004' <br /> 1326 North Market Boulevard,Sacramento,CA 95834 Lab STL,Santa Ana <br /> Project Name Don Rogers Analysis Requested <br /> Project Number 8800391A/01010000 <br /> Project Manager David Herzog N <br /> Company SHAW Environmental&.Infrastructure,Inc <br /> Address 1326 North Market Boulevard ;� o <br /> Sacramento,CA 95834 0 O0 <br /> Phone 916-565-43771 F 16-565-4�5 - <br /> Sampler's Signature <br /> Z H REMARKS <br /> SampleLAB Sample 1 Container Types <br /> ID Time ID Matrix Tedlar Preservations <br /> TNFL rpo VNor 1 1 <br /> EFFL DIN Vapor I I <br /> RELINQUISHED BY RECEIVED B RELINQUISHED BY RECEIVED BY TURNAROUND REPORT REQUIREMENTS <br /> REQUIREMENTS x I Routine Report <br /> S Signature Signature 24 hr 48 hr s day II Report(includes DUP,MS <br /> X Standard(-10-15 wosicing days) MSD,as required,may be <br /> Printed ami rented ame rGinted Name Printed Name Provide Verbal Preliminary Results charged as samples) <br /> Tim R Wnght r Provide FAX Preliminary Results III Data Validation Report <br /> Firm firmFirm Firmi Requested Report Date (includes All Raw Data) <br /> Shaw E&I In 4-2� RWQCB <br /> Date/Time { Date/Time Z Date/Time Date/Time (MDLs(PQLVTRACF#) <br /> RELINQUISHED BY ROCEYVED BY Special Instructions/Comments Container Types Key <br /> 40 ml VOA 1 <br /> Signature Signature STL 125 ml LPE 2 <br /> 1721 South Grand Avenue 500 ml LPE 3 <br /> Printed Name Printed Name Santa Ana,Ca 92705 1 liter HDPE 4 <br /> 714-258-86101 Fx 258-0921 500 ml glass 5 <br /> Firm Firm Ms Sabina qudoko I liter glass 6 <br /> 2x6 s/s ring 7 <br /> Dater'time Date/Time glass 1 8 <br />