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CHAIN OF CUSTODY 1 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 Lab: CAS,Simi Valley <br /> Project Name:Foothill Landfill,San Joaquin County Anal is Requested <br /> Project Number: 124591 (Leachate Module) <br /> Report to: Sheila Richgels <br /> Company: Shaw Environmental _ <br /> Address: 1326 North Market Boulevard A <br /> Sacramento,CA 95834 �j ; m <br /> w V w <br /> Dir Ph: (916)565-4327 / Fax: 16)565-4356 0 9 CO) c00 <br /> Al z � z � <br /> Sampler's Signature: <br /> z U :Z" U 2 > c REMARKS <br /> Sample Sample iiffi LLPE 250m1 sooml VOA Container Types <br /> I.D. Date Time I�w? <br /> Matrix :!§ NP NP $NO3 RC1 Preservations <br /> L-01 9&Vvj `l7`<< water 6 1 1 1 3 <br /> RELINQUISHED BY RECEIVED BY RRL INQUISHEDL�B RE B TURNAROUND REPORT REQUIREMF,NTS <br /> REQUIREMENTS X I. Routine Report <br /> Signature 1 Signature Signature Jignature 24 hr _4e hr 5 day II. Report(includes DUP,MS <br /> vyNJL K Standard(-J0-15wodctngdays) MSD,as required,may be <br /> Printe2me Printed Name Printed Name Printed Name Ymvids verbal PreUmmary ResuJu charged as samples) <br /> ��� CA15 ProvldeFAXPmIBmiaaryResuhs III.Data Validation Report <br /> Film Firm Firm Regaestea Repod Date: (includes All Raw Data) <br /> On— r—(blDLs/PQ1-1TRACr-,#)RWQCB <br /> eDateiMme ".1.GE� 4t4r- DaterrimDate/Time Da <br /> RELINQUISHED BY RECEIVED BY Special Instructions/Commentsr Container Types Key: <br /> Columbia Analytical 40 ml VOA: 1 <br /> Signature Signature Please report INIDLs,PQLs and Trace. 2655 Park Center Drive,Suite A 250 nil 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 BDPE: 4 <br /> Contact: Karen Ryan 500 ml glass: 5 <br /> Firm Firm UPS Acct 9653E1 1 liter glass: 6 <br /> EDDs to<susan.waterman@shawgrp.com> 2x6 s/s ring: 7 <br /> Datefrime IDatefrime, glass jar: 8 <br />