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r r r r ■r �r rr rr rr rr r� rr � s <br /> CHAIN OF CUSTODY I LABORAIVY ArNALYSIS REQUEST FORM , <br /> SHAW Envit onmental&Infrast mctuce,Inc. Purchase Order 208456 <br /> 1326 North Market Boulevard,Sacramento,CA 95834 Lab Sierra Analytical <br /> Project Name Don Rogers Analysis Requested <br /> Project Number 8800391A/01020000 <br /> Project Manager David Herzog o <br /> Company SHAW Environmental&InfraA ncture,Inc. 00 <br /> Address 1326 North Market Boulevard � <br /> Sacramento,CA 95834 �o <br /> Phone 916-565-43771 FAX 16-565-4356 <br /> i p <br /> Sampler's Signature — r <br /> REMARKS <br /> Sample LAB Sample <br /> e � 1 Container Types <br /> I D Date Time i D Matrix Tedlar Preservations <br /> R*1 .?/7/616-30 Vapor 1 1 <br /> EFFL Vapor 1 l <br /> RELINQUISHED BY RECEIVED BY RELINQUISHED BY RECEIVED BY TURNAROUND REPORT REQUIREMENTS <br /> REQUIREMENTS X I Routine Report <br /> S Signature Signature Signature z4 hr 49hr 5 day H Report(includes DUP,MS <br /> 4X Standard(—I0.15 worinng days) MSD,as required,may be <br /> ted Name Printed Name Printed Name Printed Name Prwnde verbal Preimmary Results charged as samples) <br /> Ton R_Wight Provide FAX Prelurunuy Adults 111 Data Validation Report <br /> Firm Firm Firm Firm Requested Report D= (includes All Raw Data) <br /> Shaw E&I Inc RWQCB <br /> Date/Ti nc ate�nac DateMme Date/Time (MDLs/PQLs(MCE#) <br /> RELINQUISHED BY RECEIVED BY Special Instructions/Comments �� Container Types Key <br /> 1` � 40 ml VOA 1 <br /> Signature Signature ` 1 125 ml LPE 2 <br /> Sierra Analytical 500 ml LPE 3 <br /> Printed Name Pnnted Name 26052 Ment Circle ]]iter HDPE 4 <br /> " 1 Suite 105 500 ml glass 5 <br /> Firm Finn <br /> 1 Laguna Hills,Calif 92653 1 liter glass 6 <br /> 2x6 sls rung 7 <br /> DaWTrme Date/Time , <br />