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= 4r = = = = = = = = <br /> = = = <br /> CHAIN OF CUSTODY 1 LABORAT ANALYSIS REQUEST FORM <br /> Shaw Environmental&Infrastructure,Inc Purchase Order 206765 <br /> 1326 North Market Boulevard Sacramento,CA 95834 Lab CLS Labs <br /> Project Name Parkinson's Arco,Stockton Anal sis Requested <br /> Global ED 70607700906 0 <br /> Project Number 8800401A o o <br /> Project Manager David Herzog wCA <br /> rzi '0 <br /> 00 <br /> Company Shaw Environmental&Infrastructure,Inc <br /> Address 1326 North Market Boulevard <br /> Sacramento,CA 95834 o H ?: <br /> ¢ Q <br /> Dir Ph (916)565-43771 FAX (9161565-4316 <br /> cs C7 W A <br /> Sampler's Signature z <br /> REMARKS <br /> Sample LAB Sample lContamer Types <br /> I D Date Time I D Matrix HC] Preservations <br /> MW-1 -12Water 4 4 <br /> MW-2 Water 4 4 <br /> MW-3 JA3 Z- Water 4 4 <br /> MW-4 cial Water 4 4 <br /> MW-5 ft3b Water 4 4 <br /> i <br /> RELINQUISHED BY RECEIVED BY RELINQUISHED BY RECEIVED BY TURNAROUND REPORT REQUIREMENTS <br /> REQUIREMENTS X I Routine Report <br /> Sign a Signature Signature Signature 24 hr 49 hr 5 day 11 Report(includes DUP,MS <br /> X Standard(-10-15 working days) MSD,as required,may be <br /> Pn ame Printed Name Printed Name Printed Name Provide Verbal Preliminary Results charged as samples) <br /> L6N�'/'% Provide FAX PrelimrnaryResults III Data Validation Report <br /> Firetr Firm Firm Firm Requested Report Date (includes All Raw Data) <br /> CTT RWQCB <br /> Date/Time —tZ Date/Time Date/Time Date/Time (MDLs/PQLs/fRACE#) <br /> RELINQUISHED BY RECEIVED BY Special Instructions/Comments Container Types Key <br /> 40 ml VOA I <br /> Signature Si Need EDDs for GeoTracker CLS Labs 250 ml LPI; 2 <br /> il?a Q44David Herzog@a,shawgrp com 3249 Fitzgerald Road 500 ml LPE 3 <br /> Printed Name Print-0 blame Reporting limit 5ppb for MTBE Rancho Cordova,Ca 95742 1 liter HDPE 4 <br /> i 916-638-7301/Fx 638-4510 500 m]glass 5 <br /> Firm Firm Contact Ray Oslowski 1 liter glass 6 <br /> 2x6 s/s ring 7 <br /> 'la*e Time Date/Time "j glass far 8 <br />