Laserfiche WebLink
ar� a� ar} �s = r� �r <br /> CHAIN OF CUSTODY 1 LABORATOANALYSIS REQUEST FORM4r <br /> Shaw E &I Inc.-1326 North Market Boulevard,Sacramento,CA 95834 Purchase Order # 189246 for 2002' <br /> (916)928-3300 FAX(916)928-3341 Lab Sparger Technology <br /> Project Name Don Rogers Analysis Requested <br /> Project Number 880039.1A/010V000 <br /> Project Manager David Herzog c <br /> Company Shaw Z <br /> Address 1326 North Market Boulevard o <br /> Sacramento,CA 95834 U x <br /> Phone 916-565-4370 / FAX 916-565-4356 o w <br /> Sampler's Signature x <br /> z REMARKS <br /> Sample LAB Sample 1 Container Types <br /> I D Date Time I D Matnx Tedlar Preservations <br /> Infl 114314 OW Air 1 1 <br /> EM Air 1 1 <br /> RELINQUISHED BY RECEIVED BY RELIN UISHED B ' EIVED BY TURNAROUND REPORT REQUIREMENTS <br /> Report <br /> X I Routine Ra <br /> REQUIREMENTS p <br /> Signature, Signature St ure 24hr 48hr 5day II Report(includes DUP,MS <br /> I(� [EC 114 p X Standard(-10 15 .fig days) MSD,as required,may be <br /> Printed N&ne Printed Name Printed Name Printed Name Provide verbal Prelrmmary Results charged as samples) <br /> Tint R Wnght 4 Provide FAX Prehmuiaiy Results ill Data Validation Report <br /> Firm Flim I j Firm Fi Requested Report Date (includes All Raw Data) <br /> Shaw E&I Inc 1 dL 2, QZ� �� 7. RWQC.B <br /> Date/Time t Date/Time Date/time Date/ rine (MDLs/PQLs/FRACE#) <br /> RE IN UISHED BY RECEIVED BY Special Instructions/Comments Container Types Key <br /> 40 ml VOA 1 <br /> 125 ml LPE 2 <br /> Signature Signature <br /> Sparger Tech 500 ml LPE 3 <br /> Printed Name Printed Name 3050 Fite Circle,Ste 112 1 liter HDPE 4 <br /> Sacto,Calif 95827 500 m)g)ass 5 <br /> Firm Firm 916 362-89471 Fx 362 0947 1 liter glass 6 <br /> 2%6 s/s ring 7 <br /> !Date/Tune Date(Fime glass jar 8 <br /> I <br />