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, <br /> CHAIN OF CUSTODY / LABORATORY ANALYSIS REQUEST FORM <br /> Shaw E&I W32'N-orth Market Boulevard,Sacramento,CA 95"834 Purchase Order <br /> 16 mP3909 i 9'X`Lng 928-3341 l Lab Sierra Anal cal <br /> Project Name Don Rogers sts Requested <br /> Project Number 880039.1A/01020000 II <br /> Project Manager David Herzog Ld o <br /> Company Shaw E&I Inc. 0 <br /> Address 1326 North Market Boulevard o <br /> Sacramento,CA 958 U <br /> Phone 916-5654377/ F -5 -4k6 0 <br /> Sampler's Signature <br /> Z REMARKS <br /> Sample LABSample III f! Comer Types <br /> I D ate Time I D Mamx TedW II Preservations <br /> Intl 4nqdf 0,56 VAPOR 1 I <br /> EM 0D VAPOR 1 1 EEff <br /> �I Il <br /> RELINQUI D BY RECEIVED BY RELINQUISHED II � RECEIVED BY TURNAROUND REPORT REQUIREMENTS <br /> REQUIREMENTS X I Routine Report <br /> Si Signature SignatureII � Signature 24 hr 4a hr 5day H Report(includes DUP,MS <br /> X Staridazd(-tats wodaag days) MSD,as required,may be <br /> ed Name VPrinted Name Primed Name II { Primed Name Prmde verbal Prehaurwy Resutta charged as samples) <br /> Tim R WrIgM i l ProvideFAX Prehmmxy Results III Data Validation Report <br /> Firm Firm Firm I I Firm Requested Report bete (includes Alf Raw Data) <br /> Shaw E&I Inc. I RWQCB <br /> DatelTimeV Date/Time Date/Time II II DatelTtme - L--(MDLsNLVTRACE#) <br /> 02 RELINQUIAMD BY RECEIVED BY Special Instructions/Corninents Container Tyles Key <br /> 40 ml VOA 1 <br /> Signature Signature �``� 125 ml LPE 2 <br /> Sierra Analytical 500 ml LYE -3 <br /> Printed Name Printed Name 2602 Merit Circle 1 liter HDPE 4 <br /> Laguna Hills,CA 'ZZ1 500 ml glass 5 <br /> Firm Firm <br /> " ` a <br /> 6 <br /> d, �`�310 2x6 7 <br /> 1 g <br /> it k� �S� <br />