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�w ■w w ■w� � w w w w w w�w� <br /> CHAIN OF CUSTODY t LABORATORY ANALYSIS REQUEST FORM <br /> Shaw E&I Inc.-1326 North Market Boulevard,Sacramento,CA 95834 Purchase Order t <br /> (91 928-3300 FAX(916)928-3341 Lab Sierra Analyfical <br /> Project Name Dort Rogers Analysis Requested <br /> Project Number 880039.IA/01020000 <br /> Project Manager David Herzog o <br /> Company Shaw E&I Inc. <br /> Address 1326 North Market Boulevard o <br /> Sacramento,CA 95834 �j 0C <br /> Phone 916-5654370 / FA 916-5654356 o <br /> Sampler's Signature <br /> z REMARKS <br /> Sample LAB Sample i Contamer Types <br /> ID Da Time I D Matrix Tedlar Preservations <br /> 111fl VAPOR 1 1 <br /> E$lVAPOR 1 1 <br /> RELINQUISHED BY RECEIVED BY RELINQUISHED BY RECEIVED BY TURNAROUND REPORT REQUIREMENTS <br /> REQUIREMENTS X i Routine Report <br /> Si Signature Signature Signature 24th 49 hr 5 day 11 Report(includes DUP,MS <br /> X Standard(-10 15 workmg days) MSD,as re(luu-ed,may be <br /> Printed Name Printed Name Printed Name Pnnted Mame Provide Verbal Prehmuwy Results charged as samples) <br /> Ton R.WAglit Provide FAX Prehnmary Results III Data Validation Report <br /> Firm Firm Finn Firm Requested Report parr (includes All Raw Data) <br /> Shaw E&I RWQCB <br /> IDate/Time 3� Date/Fime DateFTime Date/Time (MDLslPQLsI1 CE#) <br /> REL L SHED BY RECEIVED BY Special InArroctionslComments /�, Container Types Key <br /> 40 ml VOA. 1 I <br /> Signature Signature 125 ml LPE 2 <br /> �y Sierra Analytical 500 ml LPE 3 <br /> Printed Naive Printed Name �1 2602 Meth Cock, 1 Ther HDPE 4 <br /> Laguna Hills,CA 4?Z/o-*J 500 ml glass 5 <br /> Firm Fum 1 liter glass 6 <br /> Daxerl'mte DatelTtme n X31 <br /> 2x6 s/s nng- 7 <br />