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CHAIN OF CUSTODY / LABORATORY ANALYSIS REQUEST FORINT Page —of <br />Shaw Environmentalf 7/2/-) r-7 P.O. No: Direct Bill San Joaquin Cnty <br />1"42 K- <br />6 North MnrA* Rnavinnnr�l .C�r. nar�nnfn A ®CQ-ZA <br />Project Name: Foothill Landfill, San Joaquin County <br />'►/ <br />g ®-r <br />Analysis <br />Lau. <br />Requested <br />%-txo, JrriL V UUC. <br />Ground Water. New Well Sampling (MW -4 & 5) <br />—, <br />Project Number: 124591 <br />Report to: Sheila Richgels <br />w <br />Company: Shaw Environmental <br />00 <br />w <br />Address: 1326 North Market Boulevardt <br />j <br />x <br />Sacramento, CA 95$34 <br />w r <br />c <br />Q <br />O <br />Dir Ph: (916) 565-4327 ! Fax: 16) 565 <br />.0 <br />8e� <br />U <br />00 <br />00 <br />00 <br />A <br />Sampler's Signature: xi <br />Z Q <br />Z <br />F <br />W <br />:„ <br />U <br />v1 <br />N <br />REMARKS <br />Sample L0 Sample <br />' F Ka L LPE <br />250n -I <br />I <br />1 <br />6 <br />4 <br />3 <br />4 <br />Container Types <br />I.D. Date Time I.D. Matrix <br />x NP <br />NP <br />n2SO4 <br />RCI <br />NP <br />FIN03 <br />NaOI1 <br />Preservations <br />MW -4 1-3 ' Oib z <br />water <br />% 1 <br />1 <br />+ <br />3 <br />6 <br />1 <br />1 <br />1 <br />MW -5 Alo 2 <br />water <br />LS 1 <br />1 <br />a- a <br />3 <br />6 <br />1 <br />1 <br />1 <br />Trip Blank, <br />2 <br />2 <br />\p <br />RELIN DISHED BY <br />RECEIVED BY fps <br />RELINQUISHED BY <br />RnCE <br />TURNAROUND <br />REPORTREQUIREMENTS <br />Signature t nature <br />REQUIREMENTS <br />2t hr 48to 5 day <br />X <br />I. Routine Rq-.ort <br />II. Report (iincludes DUP, MS <br />SigX'Wal, <br />nature <br />Printed Name Printed Name �h <br />11 <br />Standud (-10.15 wrnking Jays) <br />Provide Verbal PreliminaryResults <br />MSD, as required, may be <br />charged as samples) <br />Pri Name <br />Printed Name <br />'. <br />t.r <br />Provide PAX 7kelimuiary Result4. <br />Requested Report Date: <br />III. Data Validation Report. <br />(includes All Raw Data) <br />Fir ., <br />rimirmJ <br />Date/time Dat <br />the <br />X <br />RWQCB <br />(MDLs/PQl.OrRACE#) <br />Date/Time -&- r.) <br />Date/time <br />RELINQUISHED BY <br />RECEIVED BY <br />Special Instructions/comments: <br />Container Types Key: <br />Please report MDLs, PQLs and Trace. <br />Columbia Analytical <br />2655 Park Center Drive, Suite A <br />40 ml VOA: <br />250 ml L PE: <br />I <br />2 <br />Signature <br />Signature <br />Nitrate -.Nitrogen has a 48 -lir hold time. <br />Simi Valley, CA 93065 <br />805-526-7161 / Fx 805-526-7270 <br />500 m1 LPE: <br />1 liter HDPE: <br />3 <br />4 <br />Printed Name <br />Printed Name <br />Metals: Ca, Mg, K, Na, Al, Sb, Ba, Be, Cd, Cr, Co, <br />Cu, Ag, Sn, V, Zn, Fe, Mn, As, Pb, Hg, Ni, Se, Tl <br />Contact: Karen Ryan <br />UPS Acct 9653E1 <br />500 nil glass: <br />1 titer glass: <br />5 <br />6 <br />Firm <br />Firm <br />2x6 s/s ring: <br />7 <br />Datelrimo jDaterrune <br />glass jar: <br />8 <br />