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CHAIN OF CUSTODY/LABORATORY ANALYSIS REQUEST FORM Page^of_ <br /> Shaw Environmental P.O.No: Direct Bill San Joaquin County <br /> 1326 North Market Boulevard Sacramento CA 95834 )G) a �� Lab: CAS,Simi Valle <br /> Project Name-Foothill Landfill,San Joaquin County Anal is R uested <br /> Project Number: 124591 (Ground Water) <br /> Report to: Sheila Richgels o <br /> Company- Shaw Environmental <br /> Address: 1326 North Market Boulevard Q <br /> Sacramento,CA 958M �° ¢ a y 0 '�° <br /> Dir Ph: (916)565-4327 ! F (916) 65-4356 z <br /> ; r z w <br /> 0z 43 <br /> Sampler's Signature: a <br /> �' 0 °e °� $ <br /> A b U° REMARKS <br /> Sample Sample ug' V0A rater EPE 250m1 500m1 6 Container Types <br /> L• t I.D. Date Time I.D. Matrix xc 1 NP NP IN03 NP PreL vauow <br /> Lo <br /> - water Z-- <br /> MW-2R -Iiaco 3 1 1 1 2 <br /> MW-3 •(O-�� 24— 3 1 1 1 2 <br /> l <br /> _T TTT <br /> water i <br /> Field Blank .1,. a 1# water 2 2 <br /> Tri2 BlankJ7 water 2 2 <br /> 11 TL <br /> 21?z <br /> RELINQUISHED BY RECEIVED BY RELINQUISiIED BY RECE B TURNAROUND REPORT REQUIREMENTS <br /> REQUIREMENTS X I. Routine Report <br /> SiAniturl Signature Signature S' nature2a u as br _s say H. Report(includes DUP,MS <br /> t� � slsndud(--10.15workdagdays) MSD,as required,maybe <br /> PMW N" } Printed Name Printed NamePrinted Name Provide Verbz1Re2nalnaryR salu charged as samples) <br /> eroviaaFAX PrevmiuWR ults II1.Data Validation Report <br /> -Z)�tM3 �Y, ,_ ._ 0yr Pte► Firm F Revue,ted Repon Dale: ('includes All Raw Data) <br /> X RWQCB <br /> Date/time 2-6.W,—J5 M Date/Time DateMme Dat ime (MDLsJPQLsITRACE#) <br /> RELINQUISHED BY RECEIVED BY Special 7nstrttetions/Cornments: Container Types Rey: <br /> Columbia Analytical 40 mi VOA: 1 <br /> Signature Signature Please report MDIs,PQLs and Trace. 2655 Park Center Drive,Suite A 250 ml LPE: 2 <br /> Printed Nitrate-Nitrogen has a 48-hr hold time. Simi Valley,CA 93065 500 ml LPE: 3 <br /> NamePn°ted Nartue 805-526-7161/Px 805-526-7270 1 liter HDPE: 4 <br /> Firm Firmm <br /> Contac: Karen Ryan 500 ml glass: 5 <br /> UPS Acct 9653E1 ]Iiter glass: 6 <br /> EDDs to esusart.water n rr@shawgrp.eomn 2xs/s ring: 7 <br /> Datefrime Datelrime <br /> glassjar 8 <br />