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CHAIN OF CUSTODY 1 LABORATORY ANALYSIS REQUEST FORM <br /> SHAW Environmental&Infrastructure, Inc <br /> Purchase Order 3648 for 2004' <br /> 1326 North Market Boulevard,Sacramento,CA 95834 Lab STL,Santa Ana <br /> Project Name Don Rogers Anal sls Re uested <br /> Project Number 8800391A PM 920006 0J0 I0 t0 <br /> Project Manager David Herzog <br /> Company SHAD'S'Environmental&Infrastructure,Inc t <br /> Address 1326 North Market Boulevard <br /> 0 <br /> Sacramento,CA 95834 U °0 <br /> Phone 916-565-43771 FAX 916-565-4356 w <br /> f- <br /> Sampler's Signature Do x <br /> REMARKS <br /> Sample LAB Sample 1 Container Types <br /> ID Qate Time ID Matrix4'a;, Tedlar Preservations <br /> 9,4FL 1160 VTor 1 l <br /> EFFL 0110 Vapor l I <br /> I <br /> RELINQITISHED BY RECEIVED BY RELINQUISHED BY RECEIVED BY TURNAROUND REPORT REQUIREMENTS <br /> ` REQUIIMEMENTS X I Routine Report <br /> Si g S ignature 24 hr 48 hr 5 da <br /> lPrkted ign Signature y Ii Report(includes DUP,MS <br /> 9�4111e� -- X Standard(]0.1 S w,rkmg days) MSD,as required,may he <br /> Name Pn tedNanO punted Name 1 Punted Name Provide Verbal Preliminary Rauiu charged as samples) <br /> Tim R Wright 1 Prmde FAX Preliminary RmIts III Data Val tdation Report <br /> Firm Firm Firm Firm Requested Report bate (includes All Raw Data) <br /> Shaw E&I Inc RW CB <br /> Datr1l im f 7 f? Date/Time S r` a( 1 Date/Time Date/Time (MDL-VPQLsIrRACE#) <br /> RELINQUISHED BY RECEIVED BY Special Instructions/Comments <br /> Container Types Key <br /> Signature Signature 40 ml VOA 1V STL 125 ml LPE 2 <br /> ���111 1721 South Grand Avenue 500 mI LPE 3 <br /> Punted Name Punted Name Santa Ana,Ca 92705 1 liter HDPE 4 <br /> p 714-258-8610/Fx,258-0921 500 ml glass 5 <br /> LDate/Time [Date/Tune <br /> Fig` y ``\ Ms Sabina Sudoko I liter glass 6 <br /> 2x6 s/s ring 7 glassy $ <br />