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a� <br /> man M MM <br /> CHAIN OF CUSTODY 1LABORATORY ANALYSIS REQUEST FORM page_of <br /> Shaw Environmental r1 P.O.No.-Ma"11��1� Sa1ti Joaquin County <br /> 1326 North Market Boulevard Sacramento,CA 95834 , L,�00 K—Z Lab: M-W&W-dga gdi It<c <br /> Project Name:Foothill Landfill,San Joaquin County And 's �t <br /> Project Number: 791289 *(43ei t nzT'4?at;rr), <br /> Report to: Sheila Richgels y <br /> Company: Shaw Environmental w las <br /> o cr <br /> Address: 1326 North Market Boulevard N 0 ` <br /> Sacramento,CA 95834 j 00 <br /> Dir Ph: (916)565-4327 ! FAX: (916)565-4356 o W S Ute; <br /> p b v <br /> Sampler's Signature: <br /> ZI 9 F REMARKS <br /> Sample LAB Sample 1 4 125m1 Container Types <br /> I.D. Date Time I.D. Matrix HCl NP NP HNO3 Preservations <br /> water 6 3 1 1 1 <br /> MW-2R 412 water 6 3 1 1 1 <br /> MW-3 iP-4 water 6 3 1 L 1 1 <br /> LW-1 13oZ water 6 3 1 1 1 <br /> Field Blank 1J1set water 2 2 <br /> Trip Blank water 2 2 <br /> RELINQUISHED BY RECEIVER BY RELINQUISHED BY A J REC TURNAROUND REPORT REQUIREMENTS <br /> REQUIREMENTS X I. Routine Report <br /> Signatur Signature Signature Signa a 24b(,t _48nr _5 day H. Report(includesDUP,MS <br /> X Standiu (-1445wot gaays) MSD,as required,may be <br /> PriuW Nates Printed Name Printed Name Printed Name Provide VetbalAehminaryResults charged as samples) <br /> Xov- . Ptovld6FAX ftvmnayRes Otte III.Data Validation Report <br /> FiunFirm Firm FiRequested Report nate, (includes All Raw Data) <br /> hnn Wa- Ea dZ X RWQCB <br /> Dateftime I.Z7.D/,. Dateffitne Date/time Datefrime 0,1DLs/PQLVrRACF*) <br /> RELINQUISHED BY RECEIVED BY Special Instructions/Comments: Container Types Bey: <br /> Columbia Analytical 40 ml VOA: 1 <br /> Signature Signature Please report MDLs,PQLs and Trace. 8030 Remtnet Avenue 250 ml LPE: 2 <br /> _, to1'Ni geiilii§'a{$li oiiltim Suite 500ndLPE: 3 <br /> Printed Name Printed Name Canoga Park,Ca 91304 1 liter HDPE: 4 <br /> 818-316-0904/Fx 316-0896 500 ral glass: 5 <br /> Firm Film Contact: Karen Ryan 1 liter glass: 6 <br /> ;;R4Xe num.watermm@sha cony a P�� cC lr53i 1 2x6 als ' 7 <br /> Date/Time Date/time glass jar: 8 <br />