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CHAIN OF CUSTODY/LABORATORY ANALYSIS REQUEST FORM Page_of_ <br /> Shaw Environmental P.O.No: Direct Bill San Joaquin County <br /> 1326 North Market Boulevard Sacramento CA 95834 Lab: CAS,Simi Valle <br /> Project Name:Foothill Landfill,San Joaquin County Analysis Requested <br /> Project Number: 124591 (Lysimeters) <br /> Report to: Sheila Richgels ti c <br /> Company: Shaw Environmental as w <br /> PC <br /> Address: 1326 North Market Boulevard 1 <br /> Sacrament%CA 95834 j a _ <br /> Dir Ph: (916)565-4327 / FAX: (916)565-4356 o W o �+ <br /> a~ d <br /> Sampler's Signature: U p� <ao <br /> Z E� U Z, tZ, REMARKS <br /> ample LAB Sample Li 125m1 500ml Container Types <br /> I.D. Date Time I.D. Matrix NP HNO3 Preservations <br /> LZ-01 water 3 1 1 <br /> LZ-02 water 3 1 1 <br /> LZ-03 6 1 1 <br /> LZ-04 ater 3 1 . 1 <br /> RELINQUISHED BYRECEIVED RELINQUISHED BY RECEIVED BY TURNAROUND REPORT REQUIREMENTS <br /> REQUIREMENTS X I. Routine Report <br /> Signature Signa Signature Signature uhr 48 hr _5 day 11. Report('includes DUP,MS <br /> X Standard(-10.15 worldog days) MSD,as required,may be <br /> Printed Name f6inted Name Printed Name Printed Name .. .. Provide verbelPodkoinary Results charged as samples) <br /> ProvidePAXPUbn1oMResults III.Data Validation Report <br /> Fun FFmn Firm Fun Requested Report Date: (includes All Raw Data) <br /> X RWQCB <br /> Datefl5me DatelTime Date/Time Datefrime <br /> (IvIDLs/PQLs/fRACE#) <br /> RELINQU BY RECEIVED BY Special Iastructions/Comments: Container Types Kay <br /> Columbia Analytical 40 nil VOA: 1 <br /> Signature Signature Please report MDIs,PQLs and Trace. 2655 Park Center Drive,Suite A 250 ml LPE: 2 <br /> Nitrate-Nitrogen has a 48-hr hold time. Simi Valley,CA 93065 500 ml LPE: 3 <br /> Printed Name Printed Name 805-526-7161/Fx 805-526-7270 1 liter HDPE: 4 <br /> Contact:Karen Ryan 500 int glass: S <br /> Fi® Firm UPS Acct 9653BI 1 liter glass: 6 <br /> EDDs to tsbsan.vaterman*shawgip.com> 2x6 s/s ring: 7 <br /> Datefllale Datta <br /> glassJar 8 <br />