Laserfiche WebLink
CHAIN OF CUSTODY/LABORATORY ANALYSIS REQUEST FORINT <br /> SHAW Environmental&Infrastructure,Inc. Purchase Order 3648 for 2004' <br /> 1326 North Market Boulevard Sacramento CA 95834 Lab STI.,Santa Ana <br /> Project Name Dan Rogers Anal sls Requested <br /> Project Number 9800391A/01020000 r. <br /> Project Manager David Herzog q c <br /> Company SHAW Environmental&Infrastructure,Inc. <br /> Address 1326 North Market Boulevard <br /> 0 <br /> Sacramento,CA 95834 U °p <br /> Phone 916-565-4377/ F 565-4356 a <br /> Sampler's Signature <br /> REMARKS <br /> SampleLAB Sample I Container Types <br /> ID a Time ID Matrix Tediar Preservations <br /> ML d Vapor I I <br /> EFFL Va r i I <br /> RELINQUISHED BY RECEIVED BY RELINQUISHED BY RECEIVED BY TURNAROUND REPORT REQUIREMENTS <br /> REQUIREMENTS X I Routine Report <br /> St Signature Signature Signature a hr 4a hr s day II Report(includes DUP,MS <br /> X SwWerd(-tats working days) MSD,as required,may be <br /> fizinted Name Punted Name Punted Name Punted Name Provide Verbal Prelrmmary Resits charged as samples) <br /> Tim R.Wright Provide FAX PreliminaryResulrs III Data Validation Report <br /> Firm Firm Firm Firm RaMested Report Dace (includes All Raw Data) <br /> Shaw E&I Inc - RWQCB <br /> DattdTimc 7` 117Z; DatefI"irne DatcfTime jDatelTime (MDLMLsfrRACE#) <br /> RELINQUISHED BY RECEIVED BY Special Instruetions/Comments Container Types Key <br /> 40 ml VOA 1 <br /> Signature Signature V STL 125 ml LPE 2 <br /> 1� 1721 South Grand Avenue 504 ml LPE 3 <br /> Printed Name Printed Name t� Santa Ana,Ca 92705 1 1tter HDPE 4 <br /> 714-258-86101 Fx,258-0921 500 ml glass 5 <br /> Firm Firm ir�1` p�� Ms Sabina Sudoko l liter glass 6 <br /> JJJ �1[J 1 2x6 s/s ring 7 <br /> Date/Time jDateffirne V► A 8 <br />