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CHAIN OF CUSTODY/LABORATORY ANALYSIS REQUEST FORM Page_of_ <br /> Shaw Environmental r) P.O.No: ]Direct Bill San Joaquin County <br /> 1326 North Market Boulevard,Sacramento,CA 95834 CITLab: CAS,Simi Valley <br /> Project Name: Foothill Landfill,San Joaquin County Analysis Requested <br /> Project Number: 124591 (Ground Water) <br /> Report to: Sheila Richgels n <br /> Company: Shaw Environmental [ �. Q <br /> Address: 1.326 North Market Boulevard v <br /> N = <br /> Sacramento, CA 95834 U ¢ a .� T <br /> a <br /> Dir Ph: (916)565-4327 / AX: (916)565-4356 o W o o <br /> a zu, a <br /> Sampler's Signature: U A 0 o g a, <br /> Z 9 Q U z U O v REMARKS <br /> Sample LAB Sample VOA Liter LPE 250nd 500m1 6 Container Types <br /> I.D. Date Time I.D. Matrix ; Rcl NP NP HNO3 NP Preservations <br /> MW-5 �-N-vc3 m 33 water 8 3 1 1 1 2 <br /> Trip Blank ti-vcc b t-ZiA water 2 2 <br /> RELINQUISHED BY RECEIVED BY ` RELINQUISHED BY RECCE D Y` TURNAROUND REPORT REQUIREMENTS <br /> REQUIREMENTS X I. Routine Report <br /> Sin tut Signature Signature S'gnature 2a Lr as>u 5day II. Report(includes DUP,MS <br /> -y-Standard(-10.15 working days) MSD,as required,may be <br /> t ed N p Printed Name Printed Name Printed Name provide verbal preliminary Results charged as samples) <br /> e t <br /> VL %11NNWV7 CASPMvide FAX Preliminary Results III.Data Validation Report <br /> 4 <br /> Fir Fig Firm Fi i Requested Report Date: (includes All Raw Data) <br /> t� I X RWQCB <br /> Date/Time y k— t3 DatwTime Date nine jDatefFirne. (MDLs/PQLs/rRACE#) <br /> RELINQUISHED BY RECEIVED BY Special Instructions/Comments: Container Types Key: <br /> Columbia Analytical 40 ml 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 nil LPE: 3 <br /> Printed Name Printed Name 805-526-7161/Fx 805-526-7270 1 liter HDPE: 4 <br /> Firm FirmContact: Karen Ryan 500 ml glass: 5 <br /> UPS Acct 9653E1 1 liter glass: 6 <br /> EDDs to esusan.waterman @shawgrp.com> 2x6 s/s ring: 6 <br /> Date/Time llate/Time <br /> glass jar: 8 <br />