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CHAIN OF CUSTODY/LABORATORY ANALYSIS REQUEST FORM Page—of_ <br /> Shaw Environmental Lam"' P.O.No: Direct Bill San Joaquin County <br /> 1326 North Market Boulevard Sacrament CA 95834 i���. ll/ Lab: CAS,Simi Valle <br /> Project Name:Foothill Landfill,San Joaquin County Analysis Requested <br /> Project Number. 124591 (Ground Water) <br /> Report to: Sheila Richgels c <br /> Company. Shaw Environmental <br /> Address: 1326 North Market Boulevard <br /> Sacramento,CA 95834 U <br /> Dir Ph: (916)565-4327 / FAX: 916)W-4356 <br /> Sampler's Signature: AJ! <br /> 9 L% REMARKS <br /> sample LAB S amp a VOA Liter. 125ml 500mi Container Types <br /> I.D. Date Time I.D. Matrix Pk*. HCl NP NP HNO3 Preservatiens <br /> MW-1 1035 % water 6 3 1 1 1 <br /> MW-2R i� water 6 3 1 1 1 <br /> MW-3 lam 3 water 6 3 1 1 1 <br /> LW-1 water 6 3 1 1 1 <br /> Feld Blank k.11n water 2 2 <br /> Lft Blank water 2 2 <br /> RELINQUISHED BY RECEIVED RELINQUISHED BY RE <br /> TURNAROUND REPORT REQUIREMENTS <br /> Signature Signature gnature 24R�EQU gIREMENTS 5day XJ II Rauuns Repast <br /> Report eport(includes DM MS <br /> St5ad=d(-1415 WWk1n9d9$) MSD,as required,may be <br /> N Printed Name Printed Name Printed Marge PnvAe VeAW P=hmmery ResuU charged as samples) <br /> all 7 CAS PmvldeBAXhamimokesuttsIII.Data Validation Report <br /> �-iFirm Firm t RegWWdxepmtDate: (includes All Raw Data) <br /> L d-lJ X RWQCB <br /> DatefTi— L,_31.0'7 1SM DaWTiute Dateme Date/Time <br /> (MDLS/PQLSITRACE#) <br /> RELINQUISHED BY RECEIVED BY Special Instructions/Conrmentst Container Types Key: <br /> Columbia Analytical 40 ml VOA: I <br /> Sipadue Signature Please report MDLs,PQ7Ls and Trace. 2655 Park Center Drive,Suite A 250 ail LPE: 2 <br /> Nitrate-Nitrogen has a 48-hr hold.time. Simi Valley,CA 93065 500 ml LPE: 3 <br /> Panted Name Printed Name 805-526-7161/Fx 805-526-7270 1 liter HDPE: 4 <br /> Firm Firm Contact:Karen Ryan 500 ml glass: 5 <br /> LIPS Acct 9653BI 1 liter glass: 6 <br /> EDDs to<susan.water=art@'shawgTP-ft=>. 2x6 s/s ring: 7 <br /> Datdrme DatelTitne glass jar: 8 <br />