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r �r r rr ar r rr r rr r r ri ar r rr r ® rr <br /> CHAIN OF CUSTODY /LABORATORY ANALYSIS REQUEST FORM Page—of— <br /> Shaw <br /> age_of_Shaw Environmental �� j P.O.No: Direct Bili San Joaquin County <br /> 1326 North Market Boulevard Sacramento,CA 95834 J 2Z Lab: CAS,Siml Valle <br /> Project Name:Foothill Landfill,San Joaquin County Analysis Requested <br /> Project Number: 124591 (Ground Water) <br /> Report to: Sheila Richgels a <br /> Company. Shaw Environmental ca Q <br /> Address: 1326 North Market Boulevard y <br /> 00 <br /> Sacramento,CA 95834 j ¢ a >1 <br /> Dir Ph: (916)565-4327 / FAX: /f916)5`65-4356 0 a <br /> .ui,. � <br /> Sampler's Signature: 1 UAJJr wwww Z U p o <br /> y E• v �' U REMARKS <br /> $mp1C LAB S amp a VOA UterLPE 250m1 500m! 6 Container Types <br /> I D. Date Time I.D. Matrix i ACI NP NP HNO3 NP Preservations <br /> �y MW-1 _ 1b water 8 3 1 1 1 2 <br /> - r a 1 1 <br /> 1 <br /> MW-4 . r 33 z water 8 3 1 1 1 2 <br /> — wa <br /> LW-1 ��y` tri water 8 3 1 1 1 2 <br /> a <br /> Feld-1:Tlank....._._ <br /> n <br /> RELINQUISHED BY RECEIVED BY RELINQUISHED BY RE_ TURNAROUND REPORT REQUIREMENTS <br /> SREQUIREMENTS X I. Routine Report <br /> S' Signature Signature 1 ature. zs hr 48 nr 5&y IL Repot(includes DUP,MS <br /> X sUndud(-tai5w-raogdays) MSD,as required,maybe <br /> Nanq Printed Name Printed Name Printed Na Provide verbal r4Nhama yR—Us charged as samples) <br /> UC <br /> Provide FAXPseaminwyRemlu 11L Data Validation Report <br /> Firm Firm Regaesled Repos Dare: (includes All Raw Data) <br /> 15M 66 Date/Tim Z-S^o CO DateMme Date rime Daterrime X RWQCB <br /> RELINQUISHED BY RECEIVED BY SpecW Lutructions/Comments: (MD Container <br /> Contaiaer Types Key: <br /> Columbia Analytical 40 ml VOA: I <br /> Signature Signature Please report MDL%,PQIA and Trace. 2655 Park Center Drive,Suite A, 250 ml LPH: 2 <br /> Nitrate-Nitrogen has a 48-hr hold thne. Simi Valley,CA 93065 500 ml LPE: 3 <br /> Printed Name Printed Name 805-526-7161/Px 805-526-7270 1 liter HDPE: 4 <br /> Contact: Karen Ryan 540 ml glass: 5 <br /> Firm Firm UPS Acct 9653E1 1 liter glass: 6 <br /> En <br /> Ds to"usan.watertnart@shawgrp.com> 2x6 s/s ring: 7 <br /> Dale/Titne <br /> Date/Time <br /> ® glassiar: 8 <br />