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CHAIN OF CUSTODY I LABORATORY ANALYSIS REQUEST FORM 914 IJ 2Z )(4 2 <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 Analsts Requested <br /> Project Number 8800391A/01020000 <br /> Project Manager David Herzog <br /> Company SHAW Environmental&Infrastructure,Inc <br /> kn <br /> Address 1326 North Market Boulevard <br /> Sacramento,CA 95834 <br /> Phone 916-565-43771 FAX, 91 65-4 5 4� W <br /> o <br /> Sampler's Signature -O <br /> � x <br /> Z H REMARKS <br /> Sample LAB Sample 1 Contamer TYPW <br /> I D Date Time I D Matrix Tedlar Preservations <br /> [NFL 1{ ?.1 Vapor 1 I <br /> EFFL Vapor 1 i <br /> I <br /> RELINQUISHED BY RECE D BY RELINQUISHED BY RECEIVED BY TURNAROUND REPORT REQUIREMENTS <br /> REQUIREMENTS X I Routme Report <br /> Si Signature Signature 24 hr 46 hr 5 day II Report(includes DUP,MS <br /> 1" X Standard(-10.15 worlung days) MSD,as required,may be <br /> drmtrff Name Printed Name Punted Name Provide Verbal Pretumnary Results charged as samples) <br /> Tim R Wight Prmde FAX Prehm amy Renu III Data Validation Report <br /> Firm F �J Firm Firm Requested Report Date (includes All Raw Data) <br /> Shaw E&I In T1 [� i IRWQCB <br /> Date/T,,e WV 4 ato Date/Time$2ZJ1A JQR L DatelTime Date/Time Ls/PQLs/TRACE# <br /> RELINQUZHED BY RECEIVED BY Special Instructions/Comments Container Types Key <br /> 40 nil VOA I <br /> Signature Signature \ STL 125 nal LPE 2 <br /> ' 172 South Grand Avenue 500 nil LPE 3 <br /> m <br /> Printed Name Printed Nae �hN Santa Ana,Ca 92705 1 Inter HDPE 4 <br /> 714-258-86101 Fx,258-0921 500 nil glass 5 <br /> Firm Firm ��� Ms Sabina Sudoko I liter glass 6 <br /> 2x6 s/s ring 7 <br /> DatelTime Dateffmic glass W91k 8 <br /> .r r ■r r �r � r �s rr � � � i � � <br />