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Mir M <br /> CHAIN OF CUSTODY/LABORASY ANALYSIS FORM <br /> REQUEST <br /> Shaw Environmental&Infrastructure,Inc Purchase Order 206765 <br /> 1326 North Market Boulevard Sacramento,CA 95834 Lab CLS Labs <br /> Project Name Parkmson's Arco,Stockton Anal s1s Requested <br /> Global ID T0607700906 <br /> 0 <br /> Project Number 8800401A/0201 0 o <br /> Project Manager David Herzog 5 <br /> ep Wry o N <br /> Company Shaw Environmental&Infrastructure,Inc <br /> Address 1326 North Market Boulevard <br /> Sacramento,CA 95834 c A <br /> ¢ Q <br /> Dir Ph (916)565-4377/ FAX (916)565-4 6 <br /> � � Q <br /> Sampler's Signature 1xa �' REMARKS <br /> Sample LAB Sample 1 Container Types <br /> I D Date Tune I D Matrix HCl Preservations <br /> MW-1 (a'aa, 10Z Water 4 4 <br /> MW-2 9C15 Water 4 4 <br /> MW-3 9,io I Water 4 4 <br /> MW4 ( Water 4 4 <br /> MW-5 Water 4 4 <br /> I <br /> i <br /> RELINQUISHED BY RECEIVED BY RELINQUISHED BY RECEIVED BY TURNAROUND REPORT REQUIREMENTS <br /> REQUIREMENTS X I Routine Report <br /> Sign%USignature Signature Signature 24 hr 4s hr 5 day 11 Report(includes DUP,MS"— <br /> X standard(-10.15 warlang days) MSD,as required,may be <br /> Prm ame Printed Name Printed Name Printed Name Provide Verbal Prellmrnary Results charged as samples) <br /> L j Provide FAX Prelm maty Results 111 Data Validation Report <br /> Firm ..1Firm Firm Finn Requested Report nate (includes All Raw Data) <br />` RWQCB <br /> Date/Time o Datei Time Date/Tim e Datefrune (MDLs/PQl s(MCE#) <br /> RELINQUISHED BY RECEIVED BY Speci nstructions/Comments Container Types Key <br /> 40 ml VOA 1 <br /> Signature Signa a Ds for GeoTracker CLS Labs 250 ml LPE 2 <br /> 3249 Fitzgerald Road 500 ml LPE 3 <br /> Printed Name Prtn1&d Aerie eporting limit Sppb for MTBE Rancho Cordova,Ca 95742 I liter HDPE 4 <br /> 916-638-7301/Fx 638-4510 504 ml glass 5 <br /> Firm Firm L Contact Ray Oslowski 1 liter glass 6 <br /> 2x6 s/s ring 7 <br /> DatefTrme DatefTune glass3ar 8 <br />