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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 Lab: CAS,Sin-d Valley <br /> Project Name:Foothill Landfill,San Joaquin County Analysis R nested <br /> Project Number: 124591 (Lysimeters) <br /> Report to: Sheila Richgels o <br /> Company: Shaw Environmental o <br /> Address: 1326 North Market Boulevard `O <br /> Sacramento,CA 95834 j ¢ c w <br /> Dir Ph: (916)565-4327 / FAX: (916)565-4356 o W 0 ci ;T, <br /> a °'G <br /> Sampler's Signature: v z - <br /> �. <br /> Sample Z 9 A v z U REMARKS <br /> p LAB Sample von L LPE 250m1 500,-1 Container Types <br /> I.D. Date Time I.D. Matrix HCl NP NP Preservations <br /> LZ-01 water 6 3 1 1 1 <br /> LZ-02 water 6 3 1 1 <br /> LZ-03 water 6 3 1 1 1 <br /> LZ-04 water 6 1 <br /> J. <br /> RELINQUISHED BY RECEIVED RELINQUISHED BY RECEIVED BY TURNAROUND REPORT REQUIREMENTS <br /> REQUIREMENTS X I. Routine Report <br /> Signature igfture Signature Signature 24h 48 hr 5day II. Report(includes DUP,MS <br /> X Standard(-10.15 worldngdays) MSD,as required,may be <br /> Printed Name Printed Name Printed Name Printed Name Provide verbal PreutuivaryResults charged as samples) <br /> Provide FAX Preliminary Results III.Data Validation Report <br /> Firm Firm Firm Firm Requested Report Date: (includes All Raw Data) <br /> X RWQCB <br /> Date/Time Date/Time Date/Time Date/rime (MDLs/PQLs/TRACE#) <br /> RELINQUISHED BY RECEIVED BY Special Instructions/Comments: Container Types Key: <br /> Columbia Analytical 40 nil 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 ml LPE: 3 <br /> Printed Name Printed Name 805-526-7161/Fk 805-526-7270 1 liter HDPE: 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 /> Date/Time Datefrime glass jar: 8 <br />