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it M = r M r r <br /> CHAIN IN OF CUSTODY 1 LABORATO ANALYSIS REQUEST FORM <br /> Shaw E& I Inc.-1326 North Market Boulevard,Sacramento,CA 95834 Purchase Order #189246 fo <br /> 1W <br /> (916)928-3300 FAX(916)928-3341 Lab Sparger Technolo <br /> Project Name Don Rogers Analysis Requested <br /> Project Number 9800391A/01020000 <br /> Project Manager David Herzog <br /> Company Shaw E & I Inc. <br /> Address 1326 North Market Boulevard o <br /> Sacramento,CA 95834 �j <br /> Phone 916-565-4370 / F -565 56 o <br /> Sampler's Signature x <br /> Z REMARKS <br /> Sample LAB Sample a 4' 1 Container Types <br /> I D t Time I D Matrix - f edlar Preservattovs <br /> Infl $ VAPOR 1 1 <br /> g Q VAPOR 1 1 <br /> a <br /> RELINQUISHED BY EIOED RELINQUISHED BY RECEIVED BY TURNAROUND REPORT REQUIREMENTS <br /> REQUIREMENTS X I Routine Report <br /> S e Signature Signature 24 hr 4s hr _5day I1 Report(includes DUP,MS <br /> X Standard(-10 l5 wortnng days) ISD,as required,may be <br /> mated Name zine ted Name Printed Name Provide Verbal Prelirnnary Results charged as samples) <br /> Tim R Wright Provide FAX Prebirmrary Results _III Data Validation Report <br /> i .Firm Requested Report Date (includes All Raw Data) <br /> Fant FFirm <br />� Shaw E&I Inc RWQCB <br /> Date/Tune D e Date/Time DatelTlme (MDLs/PQLsI"FR4CE#) <br /> RELIN U HED BY ECEIVED BY Special Instructions/Comments Container Types Key <br /> 40 ml VOA 1 � <br /> 125 nil LPE 2 <br /> Signature Signature <br /> Sparger Tech 5041111 LPE 3 <br /> Printed Name Punted Narne 3050 Fite Circle,Ste 112 1 liter HDPE 4 <br /> Sacto,Calif 95827 500 ilii glass 5 <br /> Firm Firm 916-362-8947 I Fx 362-0947 1 liter glass 6 <br /> 2x6 s!s nng 7 <br /> Date/Tune Date/Time €1=Jaz 8 <br /> L <br />