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60490 r M M M M W Ism W M = M M m4r <br /> CHAIN OF CUSTODY 1 LABORATORY ANALYSIS REQUEST FORM <br /> Shaw Envrrotlmenatl Purchase Order <br /> 1326 North Market Boulevard,Sacramento CA 95834 Lab CLS,Rancho Cordova <br /> Project Name Don Rodgers Anals1s Requested <br /> Global ID. T0607700717 <br /> Project Number 120221/05000000 <br /> Reportto Dan Wynne cDan.Wynne@shawgrp,conu <br /> Company Shaw Environmental <br /> Address 1326 North Market Boulevard (J °O <br /> Sacramento,CA 95834 <br /> Dir Ph 916-565-4184 / 91 - 65-43 00 -1E <br /> X •Sampler's Signature Z <br /> REMARKS <br /> Sample LAB Sample 1 contu=Types <br /> I D Date Time l D Matrix HCl P�servado <br /> MW-1R pC 0 water 5 5 <br /> ns <br /> MW-2R <br /> MW-3R water 5 5 <br /> MW4RS MD water 5 5 <br /> MW-41 water 5 5 <br /> VW-1D water 5 5 <br /> VW-2D l D s water 5 5 <br /> VW-3D nZ water 5 5 <br /> VW-4 0 water 5 5 <br /> RELINQUISHED BY RECEIVED BY RELINQUISHED BY RECEIVED BY TURNAROUND RTREQUIREMENTS . <br /> REQUIREMENTS X I Routine Report <br /> Stgnamre Signature Stgnature 24 hr 48 hr 5 day II Report(includes DUP,MS <br /> sgidard t-1o.is Worhiig days) MSD,as required maybe <br /> Phrapd N&m Printed Name Pnnted Name Printed Namc Pmnde vcrhal PRGminvy Results charged as samples) <br /> r Pmvidc FAX P dm=ryRawlis 11L Data Validation Report <br /> Firm Frio Firm Rquwwd Mpan ba<o (includes AB Raw Data) <br /> RWQCB <br /> DateFRE H Datefirtx Date�me Dat�me {MDIs/PQLOTRACE#) <br /> RELINQ D BY RECEIVED BY Special Instructlons/Comments Container Types Key <br /> Signature St 40 ml VOA 1 <br /> � Need EDDs for GeoTracker. CLS Lab 125 ml LPE 23249 Fitzgerald Road 500 ml LPE 3 <br /> Punted Name Send directly to, <snsan Waterman@shawgrp corm Rancho Cordova,Calif 95742 1 liter HDPE 4 <br /> 916-638-73011 Fx 638-4510 500 ml glass 5 <br /> Firmkk� Contact Ray OsIDwskl 1 ItterS lass 6 <br /> 2x6 sls ring 7 <br /> Dat�me Datell" -141r Pis fax rcvd chain to Sheila @916-565 4356 glass lar 8 <br />