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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 958314 Lab: CAS,Siml Valle <br /> Project Name:Foothill Landfill,San Joaquin County Anal s Requested <br /> Project Number: 124591(Surface water) <br /> Report to: Sheila Richgels c <br /> a <br /> Company: Shaw Environmental Aa ti <br /> Address: 1326 North Market Boulevard N <br /> Sacramento,CA 95834 Q 0 <br /> Dir Ph: (916)565.4327 / FAX: - (916)565-4356 6 to v �+ <br /> Sampler's Signature: y r w <br /> ° RBMARKS <br /> Sample LAB Sample VOA Liter 145.4 s Conte TA- <br /> I.D. Date Time I.D. Matrix HC1 HR03 Preservations <br /> S-1 water 6 3 1 1 <br /> S-2 water 6 3 1 <br /> RELINQUISHED BY RECEIVED BY RELINQUISHED BY RECEIVED BY TURNAROUND REPORT REQUIREMENTS <br /> REQUIREMENTS X L Routine Report <br /> Signature Signature Signature Signature as hr 481¢ 5 day IL Report(includes DUP,MS <br /> smndard�-tats waakingdays) MSD,as required,may be <br /> Printed Name Printed Name Punted Name_, . Pmvida VarbdFftumbluy Ra.ua charged as samples) <br /> Pmvl&FAX PMban gRhsuus III.Data Validation Report <br /> Firm F' BrIn <br /> Firm RegoestedRepoRDate: (includes AB Raw Data} <br /> X RWQCB <br /> DatdTlme Date/Time Datefrime Date/time <br /> (MDLs/PQLs/TRACE#) <br /> RELINQUISH» RECEIVED BY Special InstructiondCommentst Container Types ger: <br /> Columbia Analytical 40 nil VOA: 1 <br /> Signature Signature Please report MDLs,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 LME: 3 <br /> Printed Name Printed Name 805-526-7161/Fx 805-526-7270 1 liter HDPE: 4 <br /> Contact:parent Ryan 500 ml glass: 5 <br /> Fihm Firm UPS Acd 9653BI 1 liter glass: 6 <br /> EDDa to<sasan watermam @shawgrp com> 2x6 s/s ring: 7 <br /> Datdrime Date/time <br /> glmJar 8 <br />