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CHAIN OF CUSTODY/LABORAT*ANALYSIS REQUEST FORM <br /> Shaw Environmental&Infrastructure,Inc. Purchase Order 3649 for 2005' <br /> 1326 North Market Boulevar Sacramento CA 95834 Lab CLS Labs <br /> Project Name Parkinson's Arco,Stockton Analysis Requested <br /> Global LD: T0607700906 <br /> Project Number 8800401A o <br /> N <br /> Project Mnger Dan Wynne <Dan,Wynne@shawgrp,com> <br /> Company Shaw Environmental&Infrastructure,Inc, A <br /> Address 1326 North Market Boulevard X W Q <br /> Sacramento,CA 95834 <br /> Dir Ph (916)565-41841 F , (9 6) 565 356 °� d <br /> � m � A <br /> x <br /> Sampler's Signature N REMARKS <br /> Sample LAB Sample I Container Types <br /> I D Date Time I,D Matrix HCI Preservations <br /> MWA `� S L- Water 4 4 <br /> MW-2 907 Water 4 4 <br /> MW-3 231 Water 4 4 <br /> MW-4 � Water 4 4 <br /> MW-5 Ul Water 4 4 <br /> RELINQUISHED BY RECEI Y RELINQUISHED BY RECEIVED BY TURNAROUND REPORT REQUIREMENTS <br /> REQUIREMENTS X I Routine Report <br /> Signa r Sigh Signature Signature 2e hr Asa>u _s day 11 Report(includes DUP MS <br /> L� Slwdazd{—]0 IS working days} MSD,as required,may be <br /> P to aJmfeJ{ P,'',rp{��ed Pnnted Name Printed Name Provide Verbd Prelimmary Results charged as s=ples) <br /> ' �v"'w� "'• r V l "^7 Provide FAX Preliminary Re=ulU III Data Validation Report <br /> P:rpf � L Firm Firm Ftnm RoquR[ed Repon Date (includes All Raw Data) <br /> �f {� RWQCB <br /> Dattfi line Date/Timt p 0 U Date)Time Date/Time <br /> (MDLs/PQLs17RACE#) <br /> RELINQUISHED BY RECEIVED BY Spectal Instructions/Comments, Contamer Types Key <br /> 40 ml VOA l <br /> Signature Signature Need EDDs for GeoTracker CLS Labs 250 ml LPE 2 <br /> Daft,Whaw g eom 3249 Fitzgerald Road 500 ml LPE 3 <br /> Printed Name Pnnted Name Reporting limit 5ppb for MTBE Rancho Cordova,Ca 95742 1 liter HDPE 4 <br /> 916-638-7301/Fx 638.45 t0 500 ml glass S <br /> Firm Firm Contact Ray Qslowskt 1 liter glass 6 <br /> 2x6 s/s ring 7 <br /> AatelTtme I3atelTiino glass jar B <br />