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M Mir M <br /> i <br /> CHAIN OF CUSTODY 1 LABORATORY ANALYSIS REQUEST FORM <br /> Shaw Environmental&Infrastructure,Inc Purchase Order 206765 <br /> 1326 North Market Boulevard,Sacramento,CA 95834 Lab CIS Labs <br /> Project Nannie Parkinson's Arco,Stockton Anal sis Requested <br /> GlobalID T0607700906 <br /> Project Number 8800401A <br /> Project Manager David Herzog i <br /> Company Shaw Environmental&Infrastructure,Inc. <br /> Address 1326 North Market Boulevard <br /> Sacramento,CA 95834 0 a Q <br /> Du-Ph (916)565-43771 FAX (919 565-43 6 >~ Q Q <br /> � m O <br /> Sampler's Signature � H REMARKS <br /> Sample LAB Sample i Container Types <br /> ID Date Time ID Matrix HCl Preservations <br /> MW-I —t2 Water 4 4 <br /> MW-2 Water 4 4 <br /> MW-3 g3 Z Water 4 4 <br /> MW-4 Water 4 4 <br /> MW-5 3$ Water 4 4 <br /> RELINQUISHED BY RECEIVED BY RELINQUISHED BY RECEIVED BY TURNAROUND REPORT REQUIREMENTS <br /> REQUIREMENTS X I Routine Report <br /> I v Sign Signature Signature Signature 24 hr 48 hr s day II Report(includes DUP,MS <br /> X Standard(-1D 13 working days) MSD,as required,may be <br /> Prt arae a Priced Name Printed Name Printed Name Provide verbal Prchmtnary Results charged as samples) <br /> my-c-, L ~ Provide FAX Preliminary Results III Data Validation Report <br /> F1 Firm Firm Firm Requesicd Report Date (includes All Raw Data) <br /> RWQCB <br /> Date/Tune&-1Z.EHDate/time Date/Time Date/Time (MDLsIPQLs/TRACE#) <br /> RELINQUISHED BY RECEIVED BY Special Instructions/Comments Container Types Key <br /> 40 ml VOA 1 <br /> Signature Sir Need EDDs for CreoTracker CLS Labs 250 ml LPE 2 <br /> David Herzog(iDshawgip com 3249 Fitzgerald Road 500 mi LPE 3 <br /> Printed Name Pnnt D me fr Reporting limit Sppb for MTBE Rancho Cordova,Ca 95742 1 liter HDPE 4 <br /> f L w 916-638-73011Fx 638-4510 500 ml glass 5 <br /> Firm Firm GL { Contact Ray Oslows[u 1 liter glass 6 <br /> l 2x6 sls ring 7 <br /> Date/time Date/Time "1 91glassjar 8 <br />