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CHAIN OF CUSTODY I IIABORATORY ANALYSIS REQUEST FORM 030V b 1' <br /> SHAW Environmental&Infrastructure,IIIc Purchase Order <br /> 1326 North Market Boulevard,Sacramento,CA 95834 Lab Stena Analytical <br /> Project Name Don Rogers Analysts Requested <br /> Project Number SM391A/01020000 <br /> Project Manager David Herzog <br /> Company SHAW Environmental&Infrastructure,Inc. a <br /> Address 1326 North Market Boulevard S <br /> Sacramento,CA 95834 0 <br /> Phone 916-565-43771 F 916-565-4356 U X <br /> i <br /> ` o <br /> Sampler's Signature <br /> x <br /> REMARKS <br /> Sample LAB Sample n x II l II Container Types <br /> I Da e Time ID Matrix iTedlar[ Preservations <br /> INFL !� 7 D d Vapor 1 II 1 II <br /> EFFL tn Vapor 11 II 1 I[ <br /> II II <br /> ' II If <br /> I II I[ <br /> it II <br /> II I[ <br /> II I[ <br /> II I[ <br /> II I[ <br /> RELINQUISHED BY RECIVED BYI RELINQUISHED BY RECEIV>�.D BY TURNAROUND REPORT REQUIREMEWS <br /> SUite..GL II REQUIREMENTS X I Routine Report <br /> St Signature SignatureI� � Signature 24 hr 4a hr _5day 11 Report(includes DUP,MS <br /> MnSC Z H tJ L_ X Standard(-tai s w rkmg days) MSD,as required,may be <br /> Hied Name PrintedName Printed Name II Printed Name Provide Verbal Pre imtnary Results charged as samples) <br /> Tim R Wright SIG T fa (a L I! Provide FAX Preliminary Results III Data Validation Report <br /> Firm Firm Firm I Firm Requested Report Hare (includes All Raw Data) <br /> Ll Shaw E&I Inc —F-0-3 RWQCB <br /> Date/Time - 17,0V Date/Ttme Date/Time II fE Date/Tune (MDLMLvTRACE#) <br /> RELINQUISHEURY RECEIVED BY Special Instructions/CommentsContainer Types Key <br /> V Q L 40 ml VOA 1 <br /> Signature Signature "! S Q a\ r 125 m]LPE 2 <br /> � <br /> If I p � Sierra Analytical 500 ml LPE 3 <br /> Printed Name Printed Name '10 57 53 HERE ` 26052 Merit Circle 1 liter HDPE 4 <br /> Suite 105 500 m]glass 5 <br /> Firm Firm f�` LastunaH[tls,Calif 92653 lliter glass 6 <br /> J JQC 2x6s/ 7 <br /> Datenime Da e 8 <br />