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■r rr r rr rs rr r rr rr r err = = rr r r r <br /> CHAIN OF CUSTODY/LAB0RA'1Y ANALYSIS REQUEST FORM <br /> SHAW Environmental&Infrastructure,Inc. I Purchase Order <br /> 1326 North Market Boulevard,Sacramento,CA 95834 Lab STL 1 Quan{err'a,W Sacto <br /> Project Name Don Rodgers 4WAnalyses Requested <br /> Global ID: T0607700717Nor <br /> Project Number 8800391A/01050000 + <br /> Project Manager David Herzog ' <br /> Company SHAW Environmental&Infrastructure,Inc. N <br /> Address 1326 North Market Boulevard U w <br /> Sacramento,CA 95834 <br /> Dir Ph 916-565-4377 / FAX 916-565-435 ° <br /> X <br /> Samples Signature REMARKS <br /> Sample _ LAB Samp e w L - I - Captamer Types <br /> Date Time I'D atria b HC1 Preservations <br /> MW-IR8- 2� water 3 3 <br /> 3 <br /> MW-3R 10g3 water 3 3 <br /> MW-4RS a[?i water 3 3 <br /> MW-4RD water 3 3 <br /> VW-2D 1 19h water 3 3 <br /> it <br /> VW-4 L #water 3 3 <br /> RELINQUISHED BY RECEIVED BY RELINQUISHED BY RECEIVED BY TURNAROUND REPORT REQUIREMENTS <br /> REQUIREMENTS X 1 Routine Report <br /> Signatfik a Sign Signature Signature 24hr 4a hr s day II Report(includes DUP,MS <br /> standard(-.10-15%wines days) MSD,as required,may be <br /> Printed e 1 Pnnted Name Printed Name Printed Name Provide Verba!Pnimury Results charged as samples) <br /> L A= $ C,— -ocz-al a.0 PlMde FAX rieErmmaryResula m Data Validation Report <br /> Firmr Firm Firm Firm Requested RepGn Dare (includes All Raw Data) <br /> SF w StL—SA C RWQCB <br /> Date/Time -s{v'3j Date/Time 9—'4—t; f(Z.l; Date/Time Date/Time (MDLs/PQL&TRACE#) <br /> RELINQUISHED BY RECEIVED BY Special Instructions/Comments Contamer Types Key <br /> 40 ml VOA. 1 <br /> Signature Signature STL/Quanterra 125 ml LPE 2 <br /> Need EDDs for GeoTracker 880 Riverside Parkway 504 ml LPE 3 <br /> Printed Name Printed Name Report to the P M in PDF format,please W Sacto,Calif 95604 1 liter HDPE 4 <br /> <David Herzog@Shawgrp com> 916-373-5600/Fx 372-1059 500 ml glass 5 <br /> Firm Firm Contact Ion Gildersleeve I Inter glass 6 <br /> 2x6 s/s ring 7 <br /> Date/Time Date/Ttme Shaw sample coord Sheila @ 916-565-4327 Qta ,az g <br />