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mm M M M M M Mm r '�'CCr <br /> qr CHAIN OF CUSTODY/LABOI%RY ANALYSIS REQUEST FORM <br /> Shaw Enviromnental&Infrastructure,Inc Purchase Order 206765 <br /> 1326 North Market Boulevard,Sacramento CA 95834 Lab CLS Labs <br /> Project Name Parkinson's Arco,Stockton Anal sis Requested <br /> Global ID T0607700906 c <br /> Project Number 89004M <br /> Project Manager David Herzog00 <br /> Company Shaw Environmental&Infrastructure,Inc li <br /> Address 1326 North Market Boulevard U W Q <br /> Sacramento,CA 95834 0 <br /> Dir Ph (916)565-43771 F (916)565-43P6 I.. A d <br /> v U <br /> Sampler's Signature z REMARKS <br /> Sample LAB Sainple 1 Container Types <br /> ID Date Time ID Matnx HCl Preservations <br /> MW-1 Ip 11 13"`1 Water 4 4 <br /> MW-2 ��`) Water 4 4 <br /> MW-3 Water 4 4 <br /> MW-4 Water 4 1 4 <br /> MW-5 Water 4 4 <br /> RELINQUISHED BY RECEIVED BY RELINQUISHED BY RECEIVED BY TURNAROUND REPORT REQUIREMENTS <br /> REQUIREMENTS X I Routine Report <br /> Signa ' Signature Signature Signature 24 hr 48 hr 5 day Il Report(includes DUP MS <br /> X Standard(-10-35 working days) MSD,as required,may be <br /> Pri Name Printed Name Printed Name Printed Name Provndc verbal Prehrmary Results charged as samples) <br /> VL- �VnjlfKglyr ProvdeFAX PehinuiaryResults III Data VaLrdationReport <br /> Firm•I Firm Firm Firm Requested Report Date (includes All Raw Data) <br /> SH C-X-F RWQCB <br /> Datelfime i—i l v Date/Time Date/Time Date/Time (MDI s/PQLs TRACE#) <br /> RELINQUISHED BY RECEIVED BY Special Instructions/Comments Container Types Key <br /> 40 ml VOA 1 <br /> Signature Isigna Need EDDs for GeoTracker CLS Labs 256 ml LPE 2 <br /> David Herzog@shawgrp com 3249 Fitzgerald Road 5()0 ml LPE 3 <br /> Printed Name Name f Reporting limit 5ppb for MTBE Rancho Cordova,Ca 95742 1 liter HDPE 4 <br /> l 916-638-730t/Fx 638-4510 500 ml glass 5 <br /> Firm Contact Ray Oslowski 1 liter glass 6 <br /> 2x6 s/s ring 7 <br /> DatwTime Date/Time I glass Jar 8 <br />