Laserfiche WebLink
CHAIN OF CUSTODY I LABORATORY ANALYSIS REQUEST FORM Page a of _ <br />Shaw Environmental <br />' 11.z A , '— P.O. No: Direct Bill San Joaquin County <br />1326 North Marirpt Rm�ls.vaa :l C"., �..,o..+,. r• oeoae <br />17/1 <br />--- <br />Project Name: FoothllI Landfill, San Joaquin County <br />v v6z <br />IZt/ <br />LW. t„Ab, bUM Valle <br />Project Number: 124591 (Ground Water) <br />Analysis <br />Requested <br />Report to: Sheila Richgels <br />Company: Shaw Environmental <br />Gq <br />el <br />Address: 1326 North Market Boulevard <br />U <br />Sacramento, CA 95834 <br />c <br />°O <br />Dir Ph: (916) 565-4327 1 F (916) 56 -4356 <br />d <br />b <br />Sampler's s Si ature: <br />p Signature: <br />N <br />b <br />Z <br />> <br />c� <br />.. <br />�250ml <br />REMARKS <br />Sample AB ample <br />I.D. Date Time I.D. Matrix <br />VOA <br />Liter <br />500m1 <br />Container Types <br />xcl <br />NP <br />NP <br />AN03 <br />Preservations <br />MW -1 lw,1 Z <br />water <br />6 <br />3 <br />1 <br />1 <br />1 <br />MW-2R9T <br />water <br />6 <br />3 <br />1 <br />1 <br />1 <br />MW -3 1904 r <br />water <br />6 <br />3 <br />1 <br />1 <br />1 <br />LW -1 1 . Py VO'" <br />water <br />6 <br />3 <br />1 <br />1 <br />1 <br />Field Blank 144 <br />water <br />2 <br />2 <br />lLi2 Blank ).,)%i t.FQ <br />water <br />2 <br />2 <br />RELINQUISHED BY RECEIVED BY <br />RELINQUISHED BY c <br />TURNAROUND REPORT REQUIREMENTS <br />J <br />Signature <br />ignature <br />REQUENTS X <br />IREM <br />L Routine Report <br />Si Signature <br />a <br />j <br />"�' <br />24br ®r40hr 5day <br />M Report (includes DUP, MS <br />Print ame Printed Name <br />Printed Name <br />Printed Naga: <br />Slandara 5 wodtieg days) <br />MSD, as required, may be <br />^1 <br />,L w <br />Firm <br />F <br />Provide VerbalPttltnJoary Results <br />Provide PAX Prelinkuy Results <br />Requested Report Date: <br />charged as samples) <br />III. Data Validation Report <br />(includes All Raw Data) <br />tr FirmFirm <br />Date/Time <br />Daterrime <br />j <br />X <br />RWQCB <br />Datelrime .i1`i.0) s>jc:a Date/rime <br />RELINQUISHED BY RECEIVED BY <br />Special Instructions/Comments: <br />(MDLslPQLs/rRACF#) <br />Please report MDLs, PQ1A and Trace. <br />Columbia Analytical <br />2655 Park Center Drive, Suite A <br />Container Types Key: <br />40 ml VOA: <br />250.mi LPE: <br />1 <br />2 <br />Signature Signature <br />Nitrate -Nitrogen has a 48 -hr hold <br />time. <br />Simi Valley, CA 43065 <br />500 ml LPE: <br />3 <br />Printed Name Printed Name <br />805-526-7161/ ft 805-526-7270 <br />1 liter HDPE: <br />4 <br />Contact: Karen Ryan <br />500 ml glass: <br />5 <br />Fum Firm <br />EDDs to tsusanm <br />.wateran@shawgrp <br />com> <br />UPS Acct 4653E1 <br />ter glass: <br />1 l2xisls ring: <br />6 <br />6 <br />Datelrime Date/time <br />glass jar. <br />8 <br />