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CHAIN OF CUSTODY/LABORATORY ANALYSIS REQUEST FORM <br /> 4 SHAW Environmental&Infrastructure,Inc Purchase Order 3648 for 2004' <br /> 1326 North Market Boulevard Sacramento,CA 95834 Lab sn,Santa Ana <br /> Project Name Don Rogers Anal sis Requested <br /> Project Number 8800391 A/41ft DA &L'1479-00 <br /> Project Manager David Herzog N <br /> Company SHAW Environmental&Infrastructure Inc. 0 <br /> Address 1326 North Market Boulevard o <br /> Sacramento,CA 95834 VCO <br /> Phone 916-565-4377/ FAX 916-565-4356 X <br /> Sampler's Signature 0 C-5 <br /> X <br /> F" REMARKS <br /> Sample LAB Sample I Container Types <br /> I D ate Time I D Matrix Tedlar Preservations <br /> INFL Vapor 1 l <br /> EFFL oJ11D Vapor I 1 <br /> RELINQUISHED BY RECEIVED BY RELINQUISHED BY RECEIVED BY TURNAROUND REPORT REQUIR NIENTS <br /> REQUIREMENTS X I Routine Report <br /> Signature Signature 24 hr 48 eQ 5 day 11 Report(includes DUP,MS <br /> X standara(-tats work.,&n) MSD,as required,may be <br /> Prk&d Name P74edrN Punted Nacre Printed Name Ptomde Verbal Prehmmary Raalts charged as samples) <br /> Tun R Wright I PTmde FAX PreliminaryReauks III Dada Validation Report <br /> Firm FirmFirm Firm Requested Report Date (includes All Raw Data) <br /> Shaw E&I Inc RWQCB <br /> Date1T2 f 7 Date/Time 5 ".W 1 Date/Time DatelTume (MDLs/PQL,/TRACE#) <br /> RELINQUISHED BY RECEIVED BY Special Instructions/Comments _( Contamer Types Key <br /> 40 ml VOA I <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 /> 714-258-8610/Fx,258-0921 500 ml glass 5 <br /> Firm Firm Ms Sabina Sudoko 1 liter glass 6 <br /> Date/Time Date/Time y�1 vJ 2x6 s/s 7 <br /> g <br /> lass <br /> mal 8 <br /> rr rr r r■ r� r r rr F r r�r r r rr rr r� r <br />