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b <br /> CHAIN OF CUSTODY 1 LABORATORY ANALYSIS REQUEST FORM z <br /> Shaw E & I Inc -1326 North Market Boulevard,Sacramento,CA 95834 Purchase Order 2,610 L <br /> (916)928-3300 FAX 916)928-3341 Lab Sierra Analytical <br /> Project Name Don Rogers Analysis Requested <br /> Project Number 8800391A/01020000 <br /> Project Manager David Herzog o <br /> Company Shaw E&I Inc 0 0 <br /> tn <br /> Address 1326 North Market Boulevard y o <br /> Sacramento,CA 95834 VSO <br /> Phone 916-5654370 / F 9116-5 5-435 0 i <br /> Sampler's Signature x <br /> Z REMARKS <br /> Sample LAB Sample w 11 11 Container Types <br /> I D Da Time I D Matrix Tedlar II <br /> Inn d3 IVO 61 VAPOR 1 li II <br /> EM O Z VAPOR 1 11 II <br /> If li <br /> II II � <br /> 11 II <br /> II II <br /> 11 II <br /> E <br /> 11 II � <br /> II II <br /> 11 II <br /> RELINQUISHED BY_ RECEIVED BY RELINQUISHED BY (� RECEIVED BY TURNAROUND REPORT REQUIREMENTS <br /> REQUIREMENTS X I Routine Report <br /> S Si tore Signature I! Signature 24 hr as to 5 day II Report(includes DUP,MS <br /> I` —T—Standard(-10 15 working days) MSD,as required,may be <br /> Winted Name V Printed Name Printed Name II Printed Name Provide Verbal Prehmmary Results charged as samples) <br /> Tim R.Wnglit 2igg� %:� Provide FAX Prehrurnary Results III'Data Validation Report <br /> Firm F Finn �� (I Firm Requested Report Date (includes All Raw Data) <br /> Shaw E&I Inc ei 1 I RWQCB <br /> Date/Time 0 i;av Date/Time t2 •03 g•%45 Date/Tune a1 ;I Date/Time HMDl-,s/PQLs/TRACE#) <br /> RELINQUISHED BY RECEIVED BY Special Instructions/C mmienll Container Types Key <br /> !��e- <br /> n_ 125 ml LPE 2� r,p�A y�� 40 m1 V0A 1 <br /> f[ L L <br /> Signature Signature __ ll <br /> `t �-�� J Sierra Analytical 540 m[LPE 3 <br /> Printed Name Printed Name e 1 t 1S 2602 Ment Circle I liter HDPE 4 <br /> Laguna Halls,CA 500 rill glass 5 <br /> Firm Firm I liter glass 6 <br /> 2x6 s/s 7 <br /> Dat aMOM Date/T ie /0,0.0 lass 8 <br />