Laserfiche WebLink
CHAIN OF CUSTODY 1 LABORATORY ANALYSIS REQUEST FORM <br /> Shaw E&I Inc. - 1326 North Market Boulevard,Sacramento,CA 95834 Purcliase Order # 189246 3 <br /> 916 928-3300 ( Lab S ax er Technolo <br /> Project Name Don Rogers ��� �� �� Analysis Requested <br /> Project Number 880039 1A 101CW000 ,. <br /> Project Manager David Herzog a <br /> Company S 1 tQ.J ♦''C 00 <br /> Address 1326 North Market Boulevard o <br /> Sacramento,CA 95834 U <br /> Phone 916-565-437011 F 16-555-4356 0 <br /> Sampler's Signature <br /> k <br /> ZREMARKS <br /> Sample ; LAB Sample Container Types <br /> I D Patq Time I D Matnx =nom, Tedlar Preservations <br /> Infl 3 5� Air I 1,I ff I <br /> f <br /> Effl ; �i S Air 1 lel ff <br /> ' II II <br /> II ff <br /> I II ff <br /> II ff <br /> I <br /> � II ff <br /> 11 If <br /> II ff <br /> RELINQUISHED BY RECEIVED BY RELINQUISHED B [ RECEIVED BY TU"AROUND REPORT REQUIREMENTS <br /> k REQU'{REMENTS X I Routine Report <br /> Sr rgna a 5igiiatttre " If Sr 24 hr __48hr 5day II Report(includes DUP,MS <br /> �` �►' Standard(-10 15 working dais) MSD,as required,may be <br /> 6nted Name 0 1 Printed Mune Printed NameI f Pn d Na Provide Vernal Prelimvrary R-sults charged as samples) <br /> Tim R.Wnght II r L �OKProvide PAX Prelnnmary Rmilts III Data Validation Report <br /> Firm F= Fug I IFirmRequested F eporl Date (mcludes All Raw Data) <br /> sham E&i e f j� 3 3 ' e fif!!AL— <br /> RwQCB <br /> DatefTime atelTime DatefIune j 7,p0 Z' (MDIs/PQI=s/3RACE#t) <br /> REL Q SHED BY E RECEIVED BY Special Instructions/Comments Container Types Rey <br /> 44 ml VOA. 1 <br /> Signature Signature 125 ml LPE 2 <br /> I Sp irger Tech 500 nil LPE 3 <br /> Pnnted Name Printed Name 30)0 Fite Circle,Ste 112 1 hter HDPE 4 <br /> Sarto Calif 95927 500 ml glass 5 <br /> Firm i Fain 9115-362 8947/Fx 362-0947 1 liter glass 6 <br /> 2x6 s/9 7 <br /> DatelTune DatelTrine glass) 8 <br />