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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 95834y <br /> l La'U;CAS Simi Valle <br /> Project Name: I+oothffl' andfill-San Joaquin County Analysis Requested <br /> Project Number: 124591 :(Ground Water) <br /> Report to: Sheila Richgels c <br /> Company: Shaw Environmental i rq a <br /> a o cs <br /> Address: 1326 North Market Boulevard N v <br /> 00 <br /> Sacramento,CA 95834 v �, w <br /> Dir Ph: (916)565-4327 / FAX: (916)565-4356o w o <br /> ti ,p z' ai n <br /> Sampler's Signature: <br /> Z > H d z U I IREMARXS ' <br /> Sample LAB Sample von Liter LPE 250ml 500m1I lContainer Types <br /> I.D. Date Time I.D. Matrix HCl NP NP HNO3I JPreservations <br /> water 6 3 <br /> MW-2R water 6 3 1 I 1 <br /> wafer <br /> MW-4 -1 � �� water 6 3 1 1 1 <br /> MW-5 �� ,ao _ =water 6 3 I 1 1 <br /> LW-1 water 6 3 1 I 1 <br /> RELINQUISHED BY RE EIVI?, RELINQUISHED BY RECEIVED BY TURNAROUND REPORT REQUIREMENTS <br /> REQUIREMENTS X 1. Routine Report <br /> Si re Si ature Signature Signature _24 hr _4e hr ^5 day Il. Report(includes DUP,MS <br /> 1 X Standard(-10-15 working days) MSD,as required,may be <br /> ed LN`a e , , Printe_dame Printed Name Printed Name Provide Verbal Preliminary Results charged as samples) <br /> Provide FAN Preliminary Results Ill.Data.'Validation Report <br /> Ftrm E ems„ F� �O 4 b Firm Firm Regaested Repo.Date: (includes All Raw Data) <br /> r� 4 ° to X RWQCB <br /> Dateli ime pate/time Date Time Date/Time (MDIs/PQLs/IRACE#) <br /> RELINQUISHED BY RECEIVED BY Special Instructions/Comments: Container Types Key: <br /> a <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 Ftrm UPS Acct 9653E 1 l liter glass: 6 <br /> EDDs to<susan.waterman@shawgrp.com> 2x6 s/s ring: 7 <br /> DatwTime Date/time glass jar: 8 <br />