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CHAIN OF CUSTODY/ LABORATORY ANALYSIS REQUEST FORMS <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 Analysts Requested <br /> Project Number 8800391A/01020000 <br /> Project Manager David Herzog o <br /> Company SHAW Environmental&Infrastructure,Inc <br /> kn <br /> Address 1326 North Market Boulevard <br /> Sacramento,CA 95834 <br /> Phone 916-565-43771 FAX -5654356 o w <br /> Sampler's Signature <br /> E� <br /> � x <br /> a REMARKS <br /> Sample LAB Sample 1 Container Types <br /> I D V4te Time I D Matrix Tedlar Preservations <br /> INFL Q Vapor 1 1 <br /> EFFL Vapor I I <br /> W <br /> RELINQUISHED Bit RECEIVED BN RELINQUISHED BY RECEIVED BY TURNAROUND REPORT REQUIREMENTS <br /> REQUIRENIENTS X I Routine Report <br /> Si Sig re Signature Signature 24 hr 48 hr 5 dao II Report(includes DUP MS <br /> a <br /> X Standard(-10 15 working da)s) MSD as required,maN be <br /> nted Name Pri d Punted Name Printed Name Provide'verbal Preliminary Results charged as samples) <br /> Tim R Wright Provide FAX Prelimmary Results III Data Validation Report <br /> Firm Firm �� Firm Firm Requested Report Date (includes All Raw Data) <br /> Shaw E&I Inc <br /> RWQC13 <br /> Date/Time �l 4 1,04 (100 Datefrlme t-kJ 101 DatefTime Daterllme <br /> (h4DLsIPQLsITRACE4) <br /> Ii <br /> RELINQUISHED BY RECEIVED BY Special Instructions/Comments Container Types Key <br /> 40 m1 VOA 1 <br /> Signature Signature V STL 125 ml LPE 2 <br /> 1721 South Grand Avenue 500 ml LPE 3 <br /> Panted Flame Printed Name (X Santa Ana,Ca 92705 1 liter HDPE 4 <br /> 714-258-86101 Fa 258-0921 Soo ml glass 5 <br /> Firm Firm Ms Sabina Sudoko 1 Ilter glass 6 <br /> �Ai2x6 s/s ring 7 <br /> Dateflime Date/Time glassjarA11h, 8 <br /> M OPM �r rr M r Mr a M- 11WM r M M it r� �■■r <br />