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CHAEN OF CUSTODY;/LABORATORY ANALYSIS REQUEST FORM <br /> SHAW Environmental& Intfrast mature,Inc. ' Purchase Order <br /> 1326 North Market Boulevard,Sammellto,CA 95M Lab SicTIM AnalytwA - <br /> Project Name Don Rogers Analysts Requested <br /> Project Number SM391A/01020000 �I <br /> Project Manager David Herzog N <br /> Company SHAW Environmental&Infrastructure,Inc00 <br /> Address 1326 North Market Boulevard tn <br /> Sacramento,CA 95834 0 00 <br /> Phone 916-565-43771 F 916-5654356 wl <br /> Sampler's Signature <br /> k <br /> REMARKS <br /> Sample e L amp a Contanxcr Types <br /> ID a Time ID Matrix _ Tedlar Precava bow <br /> IIVF'L 4 763 tVo Vapor 1 I11 <br /> EFFL U Vapor 1g 11, <br /> I�I I <br /> II �ff <br /> II �I <br /> RELINQULSHED BY RECEIVED BY RELINQUISHED III <br /> [ RECEIVED BY TURNAROUND REPORT'REQUIREMENTS <br /> f` 1 REQUIREMENTS X I Routine Repoli <br /> Sr Signature Signature I� Signature 24 hr 48 hr _5day II Report(includes DUP,MS <br /> X Smodard(-30 15 worlung days) MSD,as required,may be <br /> rated Name Panted Name Panted Name Printed Name Provide Verbal Preliminary Results charged as samples) <br /> Tim R Wright n � Provide FAX Preliminary Rcsulu M Data Vandatlon Report <br /> Firm Firm Firm I � Firm Requested Report Date (includes All Raw Data) <br /> Shaw E&I Inc RWQCB <br /> Date/Time Datemme Date/Time jDatea me (MDLs/PQLs/TRACE#) <br /> RELIN'QUISHEV BY RECEIVED BY Special Instructions/Comments Container Types Kev <br /> 40 ml VOA I <br /> Signature Signature1\ 125 ml LPE 2 <br /> ' Y A' Sierra Analvtical 500 m[LPE 3 <br /> Printed Name Printed Name I 26052 Ment Circle I liter HDPE 4 <br /> I <br /> Finn <br /> 1 1 Suite 105 500 ml glass 5 <br /> Firm L unaHills,Calif 92653 1 litergl 6 <br /> Dat Date �� r M 2x6 _ <br />