Laserfiche WebLink
CHAIN OF CUSTODY/LABORATORY ANALYSIS REQUEST FORM Page—of_ <br /> Shaw Environmental P.O.No:Direct B111_San Joaquin County <br /> 1326 North Market Boulevard Sacrament CA 95834 Lab: CAS,:Canoga Park <br /> Project Name:Foothill Landfill,San Joaquin County Analysis Requested <br /> Project Number: 791289(Surface Water) <br /> Report to: Sheila Richgels <br /> Company: Shaw Environmental ' <br /> Address: 1326 North Market Boulevard' 3 ° ` <br /> Sacramento,CA 95834 U Q <br /> Dir Ph: (916)565-4327 / FAX: (916)565-4356 o W a o U w <br /> &; <br /> W <br /> Sampler's Signature: <br /> z > b w <br /> z;: - REMARKS <br /> Sample LAB ample 1 4 12 3 Container Types <br /> I.D. Date Time I.D. Matrix HCl NP NP HNO3 preservations <br /> S-1 water 6 3 1 1 <br /> S-2 A water 1 1 1 <br /> Klu -7 <br /> RELINQUISHED BY RECEIVED BY RELINQUISHED BY RECEIVED BY TURNAROUND REPORT REQUIREMENTS <br /> REQUIREMENTS X I. Routine Report <br /> Signature Signature Signature Signature 24 hr 4s be -5day II. Report(includes DUP,MS <br /> stndsvl((..1015 wormng days) MSD,as required,may be <br /> Printed Name Printed Name Printed Name Printed Name Provide verbal fteliminary Result charged as samples) <br /> Po)ddeFAXPreRminaryResults III.Data Validation Report <br /> Firm Firm Fun Firm Requested Report Date: (includes All Raw Data) <br /> X RWQCB <br /> Date/Time Date rime Date/Time Date/time (MDLs/PQL&TRACE#) <br /> RELINQUISHED BY RECEIVED BY Special Instructions/Comments: Container Types gey: <br /> Columbia Analytical 40 ml VOA: 1 <br /> Signature Signature Please report MDIs,PQLs and Trace. 8030 Remmet Avenue 250 ml LPE: 2 <br /> Nitrate-Nitrogen has a 48-hr hold time Suite 2 500 nil LPE: 3 <br /> Printed Name Printed Name Canoga Park,Ca 91304 1 liter HDPE: 4 <br /> Firm Firm <br /> 818-316-0904/Fx 316-0896 500 ml glass: 5 <br /> Contact: Garen Ryan 1 liter glass: 6 <br /> EDDs to tsnsan.waterman @shawgrp.com> Ship;YJPB?iccf 9653E1 r 2x6 s/s ring: 7 <br /> Date/Titne DatelTime <br /> glass jar: 8 <br />