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CHAIN OF CUSTODY/ LqABORATORY ANALYSIS REQUEST FORM 031Oll I/ <br /> SHAW Environmental&Infrastructure,Inc Purchase Order 208456 <br /> 1326 North Market Boulevard,Sacramento,CA 95834 Lab Sierra Analytical <br /> Project Name Don Rogers lysis Requested <br /> Project Number 8800391A/01020000 I <br /> Project Manager David Herzog N <br /> Company SHAW Environmental&Infrastructure,Inc <br /> Address 1326 North Market Boulevai d60 <br /> Sacramento,CA 95834 U 1 <br /> Phone 916-565-43771 FAX 916-565-4356 0 <br /> Sampler's Signature <br /> Z:1 REMARKS <br /> Sample LAB Sample - II 1 [[ Container Types <br /> I D Date Time I D Matrix - lTedl-d I Preservations <br /> iNFL ^0 t lesci 0/ Vapor 1 it 1 !� <br /> EFFL I/ey DL Vapor 1 II 1 <br /> II i! <br /> l <br /> II II <br /> II !! <br /> II II ' <br /> II II <br /> II II <br /> RELINQUISHED BY RECEIVED BY RELINQUISHED BY RECEIVED BY TURNAROUND REPORT REQUIREMENTS <br /> %. C II REQUIREMENTS X 1 Routine Report <br /> �Satur 5 nature Signature I f Signature 24 hr 4a hr 5 day II Report(includes DUP,MS <br /> X Standard(-10 15 working days) i MSD,as required,may be <br /> Printed game Printed Name Printed Name f Printed Name Pm-de Verbal Prebmmary Resuin charged as samples) <br /> Tim R Wnghtrk' ll Provide FAX Preliminary Results III Data Validation Report <br /> Firm Firm Firm II l Firm Requested Report Date I (includes All Raw Data) <br /> Shaw E&I Inc l RWQCB <br /> DatelTime UJ0 Date/Time 1p{ (Q atefftme [ [[ Date/Time (MDLs1PQLsrrRACE#) <br /> REL DISHED BY RECEIVED BY Special InstruchimslComments \ l Container Tvpes Key <br /> l 40 ml VOA 1 <br /> Signature Signature Sierra Analytical 1 125 ml LPE 2 <br /> 26052 Merit Circle,Ste 105 6 500 ml LPE 3 <br /> Printed Name Printed Name Laguna Hills,Calif 92653 I 1 liter HDPE 4 <br /> 949-348-93891 Fx 348-9115 500 ml glass 5 <br /> Firm Firm Ship Golden State Courier I liter glass 6 <br /> ,•\ 1 Acct No 14365 � � 2x6 s/s nn 7 <br /> LD at Date/Time 800-322-5555 20• g1 ass J g 8 <br />