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CHAIN OF CUSTODY/LABORATORY ANALYSIS REQUEST FORM Page_of <br /> Shaw Environmental 9 dool <br /> P.O.No: Direct Bill San Joaquin County <br /> 1326 North Market Boulevard Sacramento CA 9583493 Lab: CAS Simi Valley <br /> Project Name:Foothill Landfill,San,Joaquin County Analysis Requested <br /> Project Number: 124591 (Leachate Module) <br /> Report to: Sheila Richgels o <br /> Company: Shaw Environmental _ <br /> Address: 1326 North Market Boulevard 2' <br /> Sacramento,CA 95834 U <br /> o w U <br /> Dir Pb: (916) 565-4327 / Fax: Al6) 565-4356 0 -0 0U, c <br /> j o zZ <br /> Sampler's Signature: z <br /> i~ u o v <br /> v y <br /> Z Q v z v > REMARKS <br /> Sample LAB Sampler LLPE 250m1 500m1 VOA Container Types <br /> a <br /> I.D. Date T1IIle Matrix NP NP HNO3 HCl Preservations <br /> L-01 1 ru i tact water 6 1 1 1 3 <br /> RELINQUISHED BY RECEIVED BY RELINQUISHED Blinc, J RE B TURNAROUND REPORT REQUIREMENTS <br /> REQUIREMENTS X 1. Routine Report <br /> Signature �,u„1�,,� i Signature Signature Signature as hr 48 hr 5 day II. Report(includes DUP,MS <br /> lAAA3 '�1JU 'w X slandu (-10.15 working days) MSD,as required,may be <br /> Printed'iGytnie Printed Name Printed Name Printed Name Provide VerbalPreliniluary Results charged as samples) <br /> J V 1 Y1�1 �` C Provide FAX Prelu,unary Results III.Data Validation Report <br /> Firm S <br /> C y s Firm Firm F' Requested Report Dale: (includes All Raw Data) <br /> 1 <br /> i RWQCB <br /> Date(I'ime ,c(. `4:j Date/Time. Date/time D at X" e (MDLs/PQLs/IRACI✓#) <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 mI LPE: 3 <br /> Printed Name Printed Name 805-526-7161/Fx 805-526-7270 1 liter HDPE: 4 <br /> Contact: Karen Ryan 500 ml glass: 5 <br /> Firm Firm UPS Acct 9653131 l liter glass: 6 <br /> EDDs to<susan.waternian@sliawgrp.com> 2x6 s/s ring: 7 <br /> Datelr ime Date/time glass jar: 8 <br /> co <br />