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Shaw Environmental CHAIN OF CUSTODY/LABORATORY ANALYSIS REQUEST FORM Page_of_ <br /> 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 Analysis Re uested <br /> Project Number: 124591 (Lysimeters) £ <br /> Report to: Sheila Richgels e <br /> Company: Shaw Environmental <br /> Address: 1326 North Market Boulevard <br /> Sacramento,CA 95834 00 & <br /> Dir Ph: (916)565-4327 / FAX: (916)5654356 o w U <br /> Sampler's Signature: U cly�aa 7j4 p z w <br /> U z REMARKS <br /> Sample LAB Sample VOA LLPE 250m1 500ni1 JContainerTypes <br /> I.D. Date Time I.D. Matrix HCl NP rrP HNO3 Preservations <br /> LZ-01 water 6 3 1 1 <br /> LZ-02 water 6 1 1 1 <br /> LZ-03 water 6 f3 1 1 <br /> LZ-04 water 63 I 1 1 <br /> RELINQUISHED BY RECEIVED BY RELINQUISHED BY RECEIVED BY TURNAROUND REPORT REQUIREMENTS <br /> REQUIREMENTS X I. Routine Report <br /> Signature Signature Signature Signature 24 hr 48 hr _5 day II. Report(includes DUP,MS <br /> X Standard(-10-15 working days) MSD,as required,may be <br /> Printed Name Print ame Printed Name Printed Name Provide Verbal Preliminary Results charged as samples) <br /> Provide FAX Preliminary Results III.Data Validation Report <br /> Firm Firm Firm Firm Requested Report Data (includes All Raw Data) <br /> X RWQCB <br /> Date/Time Date/time DatetTime Datelrime r (MDLs/PQLs/TRACE#) <br /> RELINQUISHED BY RECEIVED BY Special Instructions/Comments: Container Types Key: <br /> Columbia Analytical 40 ml 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 /> Firm Firm UPS Acct 9653EI 1 liter glass: 6 <br /> EDDs to<susan.waterman®shawgrp.com> 2x6 s/s ring: 7 <br /> Date/Time IDateiTime glass jar 8 <br />