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M m m m MM MM ® m m m m M <br /> CHAIN OF CUSTODY/LABORA Y ANALYSIS REQUEST FORM 0 <br /> Shaw Environmental&Infrastructure,Inc. Purchase Order 3649 for 2005' <br /> 1326 North Market Boulevard Sacramento,CA 95834 Lab CLS Labs <br /> Project Name Parkinson's Arco,Stockton Anal sis Requested <br /> GloballD: T0607700906 0 <br /> Project Number 8800401A o a <br /> Project Mnger Dan Wynne <Dan Wynne @shawgrp.com> a <br /> Company Shaw Environmental &Infrastructure,Inc00 <br /> Address 1326 North Market BoulevardU X w A <br /> Sacramento,CA 95834 4. ¢ m <br /> Dir Ph (916)5654184/ F (916)565- 356 0 <br /> ai W A <br /> Sampler's Signature &4z ¢ REMARKS <br /> Sample LAB SampleI Container Types <br /> ID Date Time ID Matrix Ad HCI Preservations <br /> MW-1 I—L6 Water 4 4 <br /> MW-2 Water 4 1 4 <br /> MW-3 Water 4 4 <br /> MW-4 Water 4 4 <br /> MW-5 Ir Water 4 4 <br /> RELINQUISHED BY RECEIVED BY RELINQUISHED BY RECEIVED BY TURNAROUND REPORT REQUIREMENTS <br /> REQUIREMENTS X 1 Routine Report <br /> St Signature Signature Signature 24 hr 48 hr 5 day B Report(includes DUP,MS <br /> X standard(-10 15 workmg days) MSD,as required,may be <br /> P Na Printed Name Printed Name Printed Name Provide Verna[Prrtm,mary Resuhs charged as samples) <br /> fflVL Provide FAX Prebmin ry Results IQ Data Validation Report <br /> Fi> i Frrn Firm Firm Requested Report Date (includes All Raw Data) <br /> J RWQCB <br /> Datdrime J- J'71C;6 4 Date./Time Date/Time Datelrrme (MDLs/PQLs/TRACE#) <br /> RELINQUISHED BY RECEIVED BY Special Instraclions/Comments Container Types Key <br /> 40 mI VOA 1 <br /> Signature St Need EDDs for GeoTracker CLS Labs 250 nil LPE 2 <br /> Dan Wvnne@shawgrp cam 3249 Fitzgerald Road 500 ml LYE 3 <br /> Printed Namen e Reporting limit 5ppb for MTBE Rancho Cordova,Ca 95742 1 liter HDPE 4 <br /> 916-638-7301/Fx 638-4510 500 ml glass 5 <br /> Firm Fun �1Contact Ray Oslowski I liter glass 6 <br /> 2x6 s/s ring 7 <br /> DateiTime DateJTime L I- q glass jar 8 <br />