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CHAIN OF CUSTODY!LABORATORY ANALYSIS REQUEST FORM Page—of <br /> Shaw Environmental P.O.No: Direct Bill Sari,Joaquin County <br /> 1326 North Market Boulevard Sacramento CA 95834 Lab: CAS,Canoga'Park <br /> Project Name:Foothill Landfill,San Joaquin County Analysis Requested <br /> Project Number: 791289 (Lysimeters) .. <br /> Report to: Sheila Richgels <br /> Company: Shaw Environmental i w '� <br /> Address: 1326 North Market Boulevard B v, oho <br /> Sacramento,CA 95834 °O q <br /> Dir Ph: (916)565-4327 / FAX: (916)565-4356 o L <br /> y U <br /> Sampler's Signature: z <br /> z > v 8L 6 1 1 1 1 REMARKS <br /> Sample LAB Sample 1 4 125m1 3 container Types <br /> I.D. Date Time I.D. Matrix HCl NP NP 03 Preservations <br /> LZ-01 water 6 3 1 1 1 <br /> LZ-02 water 6 3 1 1 1 <br /> LZ-03 water 6 1 1 <br /> LZ-04 water 6 1 1 1 <br /> RELINQUISHED BY RECEIVED B RELINQUISHED BY RECEIVED BY TURNAROUND REPORT REQUIREMENTS <br /> REQUIREMENTS X I- Routine Report <br /> Signature Sig a Signature Signature 24 hr 43 hr 5 day II. Report(includes DUP,MS <br /> X standard(-10.15 working days) MSD,as required,may be <br /> Printed Name Printed Name Printed Name Printed Name Provide verbal Preliminary Results charged as san43les) <br /> Provide FAX Preliminary Results III.Data Validation Report <br /> Firm Firm Firm Firm Requested Report Date: (includes All Raw Data) <br /> X RWQCB <br /> Date rime Date rime Dawfrime IDategime (MDLs/PQLsfIRACE#) <br /> RELINQUISHED BYRECEIVED BY Special InstructitiorWComments: Container Types Key: <br /> Columbia Analytical 40 nil VOA: 1 <br /> Signature Signature Please report MDLs,PQLs and Trace. 8030 Remmet Avenue 250 ml LPE: 2 <br /> Nitrate-Nitrogen has a 48-hr hold time. Suite 2 500 ml LPE• 3 <br /> Printed Name Printed Name Canoga Park,Ca 91304 1 liter HDPE: 4 <br /> Firm Firm 818-316-0904/Fx 316-0896 500 ml glass: 5 <br /> Contact: Karen Ryan 1 liter glass: 6 <br /> Datelrim <br /> EDDs to<sttsanwaterman @shawgrp com> Ship UPS Acct 9653E 2x6 s/s ring: 7 <br /> e Datei TTime <br /> glass jar: 8 <br />