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CHAIN OF CUSTODY / LABORATORY ANALYSIS REQUEST FORM b3cyl $-3 <br /> Shaw E &I Inc - 1326 North Market Boulevard,Sacramento,CA 95834 Purchase Order <br /> (916)928-3300 FAX(916)928-3341 I Lab Sierra Analytical <br /> Project Name Don Rogers Analysis Requested <br /> Project Number 880039 1A/01020000 I� <br /> Project Manager David Herzog <br /> Company Shaw E &I Inc. <br /> Address 1326 North Market Boulevard Q <br /> Sacramento,CA 958 - <br /> Phone 916-56543717/ F -5 4356 0 � <br /> Sampler's Signature x <br /> I <br /> z REMARKS <br /> Sample LAB Sampleg Cosner Types <br /> ID ate Time ID Matrix a Tedlar Preservations <br /> IUD q Lfif 6$,56 di VAPOR 1, 111 <br /> EM OZ VAPOR I III <br /> 13 II`I <br /> ' I I <br /> II I i <br /> RELINQUI D BY RECEIVED BY RELINQUISHED BY RECEIVED 13Y TURNAROUND REPORT REQUIREMENTS <br /> REQUIREMENTS X I' Routine Report <br /> Sr to Si Signature { [ Signature 24 l 48 hy 5 day II Report(mcluties DUP,MS <br /> tmtef X Standard(-10 15 worlaag days) MSD,as required,may be <br /> d Name N�rree Pruned Name Printed Name Provide Verbal Prelunvinry Results charged as samples) <br /> Tun R Wright I ProvideTAX Prelurunary Results III Data Validation Report <br /> Firm Firm i Firm I Finn Requested Report Date (includes All Raw Data) <br /> Shaw E&I Inc J RWQCB <br /> Daterrime Date/Tuue 41 W LJ TD Date/T,me Date/Time - [—(MDLs PQI--TRACE#) <br /> REL QUI HED BY RECEIVED BY Special Instructions/Comments Container Types Key <br /> 1/ ` 40 ml VOA. I <br /> Signature Signature 125 ml LPE 2 <br /> 1 Sierra Analytical 500 ml LPE 3 <br /> Printed Name Printed Name 2602 Merit Circle I liter HDPE 4 <br /> Firm Firm �' <br /> d - ' Lagutta Hills CA �4ZtI 500 ml glass 5 <br /> �3 <br /> 2x6 7 <br /> D e D \1 FJass 8 <br /> II k[ <br />