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= smile,!= M M J� <br /> CHAIN OF CUSTODY 1 LABORAT 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 Anal sis Requested <br /> Project Number 8800391A/01020000 <br /> Project Manager David Herzog rA No <br /> Company SHAW Environmental&Infrastructure,Inc. 00 <br /> Address 1326 North Market Boulevard o <br /> Sacramento,CA 95834 Cj <br /> Phone 916-565-43771 FAX 16-565-43561 o <br /> Sampler's Signature <br /> REMARKS <br /> Sample LAB Sample 1 Container Types <br /> ID Date Tune ID Matrix Tedlar Preservations <br /> IlVFL 7//0/01 toa Vapor 1 I I <br /> EFFL Vapor I I <br /> I <br /> RELINQUISHED BY RECEIVED BY RELINQUISHED BY RECEIVED BY TURNAROUND REPORT REQUIREMENTS <br /> REQUIREMENTS X I Routine Report <br /> Si- Signature Signature Signature 24 hr 4e hr 5 day II Report(includes DUP,MS <br /> —z–� X Standard(-16.15 working days) MSD,as required,may be <br /> Pr ted Name Printed Name Pnnted Name Punted Name Provide Verbal Preliminary Results charged as samples) <br /> Tim R Wright Provide FAX Preliminary Results III Data Validation Report <br /> Firm Firm Firm Firm Requested Repert Date (includes All Raw Data) <br /> Shaw E&I Inc RWQCB <br /> Date/Time Jp,75 Z Date/Time Date/Time Date/Time (MDLs/PQLs/TRACE#) <br /> RELIN UISHED BY RECEIVED BY Spectral Instructions/Comments Container Types Key <br /> 40 ml VOA 1 <br /> Signature Signature STL 125 ml LPE 2 <br /> `�1] <br /> 1721 South Grand Avenue 500 ml LPE 3 <br /> 'rented Name Printed Name nQ Santa Ana,Ca 92705 1 liter HDPE 4 <br /> 714-258-8610/Fx,258-0921 500 ml glass 5 <br /> 1rm Firm �A \ Ms Sabina Sudoko I liter glass 6 <br /> "J \ 2x6 s/s ring 7 <br /> )ate/Time Date/time glass Jar 8 <br />