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M. r M M �M M <br /> CHAIN OF CUSTODY / LABORATO ANALYSIS REQUEST FORM _ <br /> Shaw E &I Inc. -1326 North Market Boulevard,Sacramento,CA 95834 Purchase Order <br /> (916)928-3300 FAX(916)928-3341 Lab Sierra Analytical <br /> Project Name Don Rogers Anal sis Requested <br /> Project Number 880039.1A/01020000 <br /> Project Manager David Herzog <br /> Company Shaw E& I Inc (U OC <br /> Address 1326 North Market Boulevard o <br /> Sacramento,CA 95834 U 00 <br /> Phone 916-5654370 1 F 916-565-4356 . o <br /> Sampler's Signature <br /> x <br /> Z REMARKS <br /> Sample LAB Sample � 1 Container Types <br /> I D pate Time I D Matrix Tedlar Preservatioiis <br /> Infl I VAPOR I I <br /> Effl VAPOR I I <br /> I <br /> i <br /> RELINQUISHED BY RECEIVED BY RELINQUISHED BY RECEIVED BY TURNAROUND REPORT REQUIREMENTS <br /> ♦ REQUIREMENTS X I Routme Report <br /> St a Signatiiy� Signature Signature 24 is 48 hr 5 day II Report(includes DUP,MS <br /> L'� X Standard(-16-15 working days) MSD,as required,may be <br /> Printed Name Printed Name Printed Name Printed]Name Provide verbal Prelunuiary Results charged as samples) <br /> .R.Wright CHO-Ls i`r�q Provide FAX PrehmmeryResults III Data Validation Report <br /> Firm Firm Firm Firm Requested Report Date (includes All Raw Data) <br /> Shaw E&I In St RWQCB <br /> Date/Tune 31 Date/Time S Q3 1p.3 Date/Tune Date/Time (MDLslPQLsITRACE#) <br /> RELMOITISHED BY RECEIVED BY Special Instructions/Comments �} Cordwrier Types Key <br /> �w" 40 ml VOA. i <br /> Signature Signature �JL �V 125 m1 LPE 2 <br /> 1� Sierra Analytical 500 ml LPE 3 <br /> Pruned Name Printed Name2602 Merit Circle/�14 1 liter HDPE 4 <br /> Laguna Bills,CA 9Z653 500 ml glass 5 <br /> Firm Finn 1�� 1 liter glass 6 <br /> 2x6 sls ring 7 <br /> Date/Time DatelTime Shia' 8 <br />