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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 Lj <br /> Lab3XAS;-Simi Valley"` <br /> Project Name:FoothIRT"iffidfUl-San Joaquin County Analysis Requested <br /> Project Number 124591 v(Grouhd Water) <br /> Report to: Sheila Richgels <br /> 'Y2 <br /> C6 mpany: Shaw Environmental 6. <br /> U <br /> Address: 1326 North Market Boulevard .9 <br /> . r. 00 1E <br /> Sacramento,CA 95834 0 < Z.2-0 Of -Z <br /> 41 z 4, <br /> Dir Ph: (916)565-4327 FAX: (916)565-4356 <br /> nii .2 <br /> z <br /> Sampler's Signature: 9 <br /> aA C, <br /> > REMARKS <br /> Sample LAB Sample ;;, von Liter LPE 250ml 500m] Container Types <br /> I.D. Date Time I.D. Matrix HCl NP NP IIN03 I lPreservations <br /> water 6 3 1 <br /> MW-2R ND water 6 3 <br /> MW-4 water 6 3 <br /> MW-5 —V-2so 1goo `water 1 6 3 1 1 1 <br /> LW-1 -7.3%) water 6 3 1 1 1 <br /> --watef— <br /> P44 -7— <br /> RELINQUISHED BY REEIV RELINQUISHED BY RECEIVED BY 'TURNAROUND REPORT REQUIREMENTS <br /> REQUIREMENTS X 1. Routine Report <br /> Si= Si ature Signature Signature N l" 48 lur 5 day 11. Report(includes DUP,MS <br /> X <br /> I Standard(•-10-15 v.,ki.,days) MSD,as required,may be <br /> PrAed Na1RC Pi teiiName Printed Name Printed Name Provide Verbal Preliminary Results charged as samples) <br /> Provide Nkx,?relimmary Results 111.Data Validation Report <br /> Finny Firm Firm Finn Rqu.,.d R.p.,i Dom: (includes All Raw Data) <br /> W7,lee r'w&> <br /> X RWQCB <br /> Date/7ifne Pate/Time Date.7ime Date/Time (MI)I_s/PQI_sJ7RACEN) <br /> RELINQUISHED IRV RECEIVED BY Special Instructions/Comments: Container Types Key: <br /> Columbia Analytical• 40 nil VOA: I <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/Fx 805-526-7270 1 liter HDPE: 4 <br /> Contact. Karen Ryan 500 ml glass: 5 <br /> Finn Firm UPS Acct 9653E1 I liter glass: 6 <br /> EDDs to<sussit.Nvaterniaii@slinwgrp.com> 2x6 s/s ring: 7 <br /> iDate/Time Daterl"ime glassjan 8 <br />