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CHAIN OF CUSTODY/LABORATORY ANALYSIS REQUEST FORM[ Page—of— <br /> Shaw Environmental P.O.No: San Joaquin County P.O.#21356 <br /> 1326 North Market Boulevard Sacramento,CA 95$34 —\b 41 Lab: BC Labs,Bakersfield <br /> Project Name: Foothill Landfill,San Joaquin County Anal is Requested <br /> 5-Year COC Event/Ground Water b <br /> Project Number: 124591 MA <br /> Report to: Sheila Mchgels(916-565-4327) I <br /> a O <br /> <shella.richgels@a shawgrp.com> a -- 4 ao <br /> cc Report to: Jody Rhoades(916-565-436:) <br /> <jody.rlioadesQsltawgrp.com) z <br /> p U v oov V <br /> Sampler's Siguature: �° a ¢ w v, REMARKS <br /> U <br /> ren <br /> $aIIlpie LAB Sample Liter LPE 500018 VOAs L Gls 500mt 50Um1 500m1 Container Types <br /> NP D fiCl NP HNO3 NaoH Preservations <br /> 1. Date Time I.D. Matrix <br /> — ' MW-2R -1"1 l water 3 1 1 ] <br /> 14 <br /> /_4 water <br /> —2 MW_5 -1"� `� water 1 ] 1 1 3 4- ] 1 1 <br /> LW-1 —tib C> water , 1 1 3 <br /> Field Blank 8-In m IA I waterWkILrA <br /> t <br /> RELINQUISIiL'D BY RECEIVED BY RELINQUISHED BY RECEIVED BY TURNAROUND REPORT REQUIREMENTS <br /> REQUIREMENTS X L Routine Report <br /> Si ore Si+ turn Sin oro Signature 24te _481a _`sdey II, Report(includes DUP,MS <br /> ��. %ahLX slmawrdt-to-ls wcrewy myv> MSD,as required,tray be <br /> t d Nume P' d Num P''ted N e Printed Nume Prmid Verbal Prul ruauuy Reanl„ charged as samples) <br /> �j Gj„ Provide PAX Pralbobsuy Results 111.Data Validation Report <br /> �)pl �(.F✓1C 5 � Provaewd Report Date: <br /> (includes All Raw Data) <br /> Firm�^^ Firm Pi Fimi X l2WQCB <br /> Date/Time �1'? ,_ 61) Date/Time • <br /> RECE p Date/Time V pC Date/Th (MDLs/PQ n/rTypest) <br /> RELINQUISHE BY E BY SpecialInstructlons/Connnouts: ContainarTypesKey: <br /> RETERTO Table VI ATTACHED fur 5-YR Parameters. BC Labs-Tina Gruen 40 nil VOA: I <br /> Si lo Please report MDLs,PQLs and Trace. 4100 Atlas Court 250 ml LPE: 2 <br /> Signature bnoBakersfield,Cu 93308 500 ml LPG: 3 <br /> X01-" Nitrate-Nitrogen has a 48-hr hold time. <br /> Prime Nume Printed Name 661-327-4911/Fx:327-1918 1liter HDPL': 4 <br /> Ship via UPS Acct 965376 500 nil glass: 5 <br /> Finn Firm � Mctuls: Ca,Mg,K,Na,Al,Sb,Be,Be,Cd,Cr,Co, Field Support: Peter Bins I titer glass: 6 <br /> 47.OctZ lit� Cu,Ag,Sn,V,Zn,Fe,Mn,As,Pb,Hg,Nl,se,'rl (408)391-2942 2x6 We ring: 7 <br /> 1 <br /> glass jar: 8 <br /> Date/Time rhila/1 tttie <br /> .._.. _ ... ....... _...__. - ...._..._.. _..... _....,.. .... ...._.. .................-_....._.... _. .__...... .._......._. ....... . ........- <br />