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CHAIN OF CUSTODY / LABORATORY ANALYSIS REQUEST FORM <br />Shaw Environmental P.O. No: <br />1326 North Market Boulevard, Sacramento CA 95834 0r) 70 Lab: <br />Project Name: Foothill Landfill, San Joaquin County Analysis Requested <br />Ground Water. New Well Sampling (MW-4 & 5) <br />Project Number: 124591 > <br />Report to: Sheila Richgels <br />F <br />Company: Shaw Environmental '� a �^ � o¢ a� <br />o w °.3 obi <br />Address: 1326 North Market Boulevard � � W ¢ � <br />Sacramento, CA 95834 o J 0 �co <br />Dir Ph: (916) 565-4327 / Fax: 16) 565-4356 o in3 Z <br />p U f13 + <br />A. "04 - 9 N `� b g <br />00 00 <br />Sampler's Signature: A � •- a' Q a 9 q <br />4--� 4 <br />Z F U p., <br />Sample ample L LPE 250ni 1 1 6 4 v 3 4 <br />I.D. Date Time I.D. Matrix NP NP H2So4 Act NP HKO3 NaOH <br />MW-4 �- \�'� water 1 1 ffit 3 6 1 1 1 <br />Page _ of — <br />Direct Bill San Joaquin Cnty <br />CAS, Simi Valle <br />REMARKS <br />Container Types <br />Preservations <br />MW-5 <br />water <br />Lsi <br />1 <br />1 <br />#- t <br />3 <br />6 <br />1 <br />1 1 <br />Trip Blank <br />2 <br />2 <br />RELIN DISHED BY <br />RECEIVED BY <br />RELINQUISHED BY RFC <br />Signature t acture <br />Printed Name Printed Name <br />Fum F <br />Date/time Da <br />TURNAROUND <br />REQ <br />REQUIREMENTS <br />24 hr _48ur _5day <br />-y—Standard (-10-15 woddog days) <br />Frovtde VerbalPrellmloaryResults <br />ProvidePAXPrelindusryReaults <br />uestedRe4 Pon Date: Re <br />REPORT REQUIREMENTS <br />X I. Routine Report <br />II. Report (includes DUP, MS <br />MSD, as required, may be <br />Y <br />Chazged as samples) <br />III. Data Validation Report <br />(includes All Raw Data) <br />X RWQCB <br />Sig a <br />IF--Name <br />�� t <br />Signature <br />Priated Name <br />Rime" _ <br />Firm <br />Date rime �.3! ti) <br />Date/time <br />RELINQUISHED BY RECEIVED BY <br />Signature Signature <br />Printed Name Printed Name <br />Firm FM <br />DateJDme Date/time <br />Special Instruction7Cotnments: <br />Please report MDLs, PQLs and Trace. <br />Nitrate-Nitrogen has a 48 hr hold time. <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, M <br />(MDLs/PQLs/1'RACE#) <br />Colombia Analytical <br />2655 Park Center Drive, Suite A <br />Simi Valley, CA 93065 <br />805-526-71611 Fx 805-526-7270 <br />Contact: Karen Ryan <br />UPS Acct 9653131 <br />Container Types Key: <br />40 ml VOA: <br />250 ml LPE: <br />500 W LPE: <br />1 liter HDPE: <br />500 ml glass: <br />1 liter glass: <br />2x6 sts ring: <br />glass jar. <br />1 <br />2 <br />3 <br />4 <br />5 <br />6 <br />7 <br />8 <br />