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MM <br /> CHAIN OF CUSTODY/ LABORATOR ALYSIS REQUEST FORM . <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 Analysts R uested <br /> Global ID. T0607700906 c <br /> Project Number 8800401A o o <br /> Project Mnger Dan Wynne <Dan Wynne@shawgrp,com> n m o <br /> Company Shaw Environmental&Infrastructure,Inc. �_ > <br /> Address 1326 North Market Boulevard U X w �'' p <br /> Sacramento,CA 95834 a N w <br /> Dir Ph (916)565-41841 FA ( 1 ):516556 <br /> �. Q <br /> D <br /> Sampler's Signature u Z r' REMARKS <br /> Sample LAB Sample ;""o 1 Container Types <br /> I D Date Time I D Matrix r HCl Preservations <br /> MW-1 10-J-) s3 Water 4 4 <br /> MW-2 I;a1 Water 4 4 <br /> MW-3 wrlb I Water 4 4 <br /> MW-4 3'fL- I Water 4 4 <br /> MW-5 `l Water 4 4 <br /> RELIN UISHED BY RECEIVED BY RELINQUISHED BY RECEIVED BY TURNAROUND REPORT REQUIREMENTS <br /> REQUIREMENTS X I Routine Report <br /> Sign Signature Signature Signature 24 hr 49 hr 5 day II Report(includes DUP,MS <br /> X Standard(-10 15 working days) MSD as required,maybe <br /> Pnnt ame Pnnted Name Printed Name Pnnted Name Provide Verbal Preirminmy Results charged as samples) <br /> Provide FAX Preliminary Results III Data Validation Report <br /> Firjw Firm Firm Firm Requested Report Date (includes All Raw Data) <br /> ' ,� RWQCB <br /> Datef urie Date1T> Date/Time jDateiTime (MDLs/PQLs/TRACE#) <br /> RELINQUISHED BYRITC IV D BY Special Instructions/Comments Container Types Key <br /> 40 ml VOA I <br /> Signature Need EDDs for GeoTracker CLS Labs 250 ml LPE 2 <br /> Dart KMe&hawUp Com 3249 Fitzgerald Road 500 ml LPE 3 <br /> Printed Name n ame Reporting limit Sppb for MTBE Rancho Cordova,Ca 95742 1 liter HDPE 4 <br /> 916-638-7301/Fx 638-4514 500 ml glass 5 <br /> Finn Firm �v Contact Ray Oslowski l liter glass 6 <br /> 2x6 s/s nng 7 <br /> DatetTime 1DatWTiM__J___ glassJar 8 <br />