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r r r rs �r i■r r r rr rr r r ar rs , rr <br /> 40 CHAIN OF CUSTODY 1 LABORATOR*ALYSIS REQUEST FORM <br /> Shaw E&I Inc. -1326 North Market Boulevard,Sacramento,CA 95834 Purchase Order #189246 <br /> 9M6 928-3300 Lab Sparger Technology <br /> 'roject Name Dan Rogers Analysis R uested <br /> 'rolecl Number 8800391A 1010, 0000 <br /> 'rolect Manager David Herzog o <br /> ;olnpany S <br /> address 1326 North Market Boulevard ro o <br /> Sacramento,CA 95834 <br /> Phone 916-5654370 1 F 16-565-4356 c <br /> �. P1 <br /> 'sampler's Signature <br /> Z REMARKS <br /> Sample LAB Sample1 Contatner Types <br /> I D at Time I D Matrix T 1 - Preservations <br /> Infl ➢.,:) 47-�TT Air I 1 <br /> EM �i i s Air 1 1 <br /> tELINQUISHED BY RECEIVED BY RELINQUISHED B RECEIVED BY TURNAROUND REPORT REQUIREMENTS <br /> ,r REQUIREMENTS X I Routine Report <br /> i ur / ]gnat re Signature Si 24hr 461ir 5day 11 Report(includes DUP,MS <br /> L X Standard(–to 15%orkN days) MSD,as required,may be <br /> of <br /> anted Name Y Printed Name Printed Name Pr n d N Provide Verbal Prehminary Results charged as samples) <br /> un R Wright l Provide FAX Preliminary Results III Data Validation Report <br /> rrrn F:2�-4L-5 <br /> Firm Firm Requested Reped Da a (includes All Raw Data) <br /> haw E&I c }' Q RWQCB <br /> )ate/Time ate/ ime ate/Time Date/Time j ZO 0 (MDLsIPQLs/TRACE#) <br /> RELONQVISHED BY RECEIVED BY Specie]Instructions/Comments Container Types Ivey <br /> 40 ml VOA I <br /> rgnature Signature 125 nil L.PE 2 <br /> Sparger Tech 500 ml LPE 3 <br /> tinted Name Printed Name 3050 Fite Circle,Ste 112 1 liter HDPE 4 <br /> Sacto Calif 95827 500 nil glass S <br /> irm Firm 916 362-89471 Fx 362-0947 1 liter glass 6 <br /> 2x6 srs ring 7 <br /> )ate/Time Date/Time glass far 8 <br />