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CRAIN OF CUSTODY/ LABORATORY ANALYSIS REQUEST FORM <br /> SHAW Environmental&Infrastructure,Inc Purchase Order ; 208456 <br /> 1326 North Market Boulevard,Sacramento,CA 95834 11 Lab Sierra Anal teal <br /> Project Name Don Rogers Analysis Requested ca I 10 Z <br /> Project Number 8800391A/01020000 I^ <br /> Project Manager David Herzog civ <br /> Company SHAW Environmental&Infrastructure,Inc co <br /> Address 1326 North Market Boulevard <br /> i <br /> Sacramento,CA 45834 U 0, <br /> Phone 916-565-43771 FAX 916-565-4356 o uxa <br /> N <br /> eq <br /> C7 <br /> Sampler's Signature � x <br /> Z H REMARKS <br /> Sample LAB Sample Container Types <br /> I D Date Time I D Matrix Tedlar[[ Preservations <br /> a rNFL G{3 Vapor 1 II 1 II <br /> D2_ EFFL Vapor 1 III II <br /> !I II <br /> II II <br /> II II ' <br /> II fl <br /> II II <br /> II II <br /> �I I[ <br /> REL Q ISHED BY RECEIVED B1 RELINQUISHED BY ff RECEIVED BY TURNAROUND REPORT REQUIREMENTS <br /> I[ 4 REQUIREMENTS X I Routine Report <br /> ign <br /> e: Signature Signature I Signature 24 hr 4s hr s day II' Report(includes DUP,M5 <br /> X Standard(-10.15 working days) MSD,as required,may be <br /> Printed Name Printed Name Printed Name, Printed Name Provide verbal Preliminary Resulrs charged as samples) <br /> Tim R Wright <br /> I Provide FAX Preliminary Results III Data Validation Report <br /> Firm Firm Firm Firm Requested rt Dare <br /> e�, � , (includes All Raw Data) <br /> Shaw E&I Inc RWQCB <br /> Date/Time /ice 3r Date/Time Date/Time JDate/Time (MDLs/PQLs/TRACE#) <br /> REI QUISHED BY C IVE Special Instructions/Comments ` i Container Types Key <br /> 40 nil VOA I <br /> Signature Signature \`3 f1� Stena Analytical 125 ml LPE 2 <br /> V 26052 Merit Circle,Ste 105 500 ml LPE 3 <br /> Printed Name Printed Name ( Laguna lulls,Calif 92653 1 1 liter HDPE 4 <br /> �Z t 949-348-9389/Fx 348-9115 500 ml glass 5 <br /> Firm firm ` J Ship Golden State Courier ] liter glass G <br /> ck 30 c� 1� Acct No 14365 I 2x6 s/s ring 7 <br /> Datt/Time Date/Time 800-322-5555 glass3 8 <br /> C <br />