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M M M M M <br />CHAIN OF CUSTODY / LABORATORY ANALYSIS REQUEST FORM Page _. of _ <br />Shaw Environmental P.O. No: Direct Bill San Joaquin County <br />1326 Nnrth Market Rnnlpvarrl Carra>»ne.4.. 91A organ <br />' <br />Project Name: Foothill Landfill, San Joaquin County <br />1= L;Aa, Wmi Valley <br />Analysis <br />Requested <br />Project Number: 124591 (Surface Water) <br />Report to: Sheila Richgels <br />o <br />Company: Shaw Environmental <br />N <br />Address: 1326 North Market Boulevard <br />Sacramento, CA 95834 <br />o 00 <br />Dir Ph: (916) 565-4327 1 FAX: (916) 565-4356 <br />U Q <br />6 <br />.9 <br />a <br />Sampler's Signature: <br />Z <br />o <br />C��, <br />o <br />ample LAB <br />ample voA <br />�" <br />U <br />5001 <br />REMARKS <br />I.D. Date Time I.D. Matrix HCl <br />NP <br />Container Types <br />HNO3 <br />Preservations <br />S-1 <br />water 6 <br />1 <br />1 <br />1 <br />S-2 <br />water 6 <br />1 <br />1 <br />1 <br />01 <br />RELINQUISHED BY <br />RECE BY <br />RELINQUISHED BY <br />RECEIVED BY <br />TURNAROUND REPORT REQUIREMENTS <br />Si <br />Signature <br />REQi HaME.NTS X <br />I. Routine Report <br />Signature <br />Signature <br />24 Lr 49 Lr 5 day <br />II. Report ('includes DUP, MS <br />Printed Name <br />Printed Name <br />X Stu dard(»10.15woikingdays) <br />MSD, as required, may be <br />Printed Name <br />Printed Name <br />Pmvide Verba1PreiimioaryResn1ts <br />charged as samples) <br />Firm <br />ProV1&FARF"BminaryResn1ts <br />III. Data Validation Report <br />Firm <br />Fu -m <br />RegnestedReportDate: <br />(includes All Raw Data) <br />Date/Time <br />Date/Time <br />X <br />RWQCB <br />(MDLs/PQLsfrRACE#) <br />Date/Time <br />Date/Time <br />RELINQUISHED BY <br />RECEIVED BY <br />Special Instructions/Commeats: <br />Container Types Bey: <br />Please report MDLs, PQLs <br />and Trace. <br />Columbia Analytical <br />2655 Park Center Drive, Suite A <br />40 ml VOA: <br />250 ml LPE: <br />1 <br />2 <br />Signature <br />Signature <br />Nitrate -Nitrogen has a 48 -hr <br />hold <br />time. <br />Simi Valley, CA 93065 <br />805-526-7161/Fx 805-526-7270 <br />500 ml LPE: <br />l liter HDPE: <br />3 <br />4 <br />Printed Name <br />Printed Name <br />Contact: <br />Contact: Karen Ryan <br />500 ml glass: <br />5 <br />F1rrr1 <br />Firm <br />Acct 9653E1 <br />l liter glass: <br />6 <br />EDDs to esusan.waterman®shawgrp.com> <br />2x6 s/s ring: <br />7 <br />Date rime <br />Date/Time <br />glass jar: <br />8 <br />