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CHAIN OF CUSTODY/ LABORATOY ANALYSIS REQUEST FORM Page o <br /> Shaw Environmental P.O.No: San Joaquin County P.O.#21356 <br /> 1326 North Market Boulevard Sacramento CA 95834 Lab: BC Labs Bakersfield <br /> Project Name:Foothill Landfill,San Joaquin County Anal sis Requested <br /> 5-YR COC Event/Lysimeters <br /> Project Number: 124591 y <br /> Report to: Sheila Richgels(916-565-4327) w a b <br /> <sheila.richgels@shawgrp.com> oo <br /> cc Report to: Jody Rhoades(916-565-4362) U <br /> <jody.rhoades@shawgrp.tcom) o o 0 o c ¢ d 3 <br /> s z <br /> z <br /> 4OAs z as Sampler's Signature: ti REMARKS <br /> U U cnSample LAB Sample Liter LPE 500 G1 L G 500m1 500ml 500m1 Container Types <br /> I.D. Date Time I.D. Matrix NP NP P HNO3 NaOH -- Preservations <br /> LZ-01 water 14 1 1 1 <br /> LZ-02 water 14 1 3 1 1 1 <br /> LZ-03 water 14 1 1 3 1 1 1 <br /> LZ-04 water 1 3 1 1 1 <br /> RELINQUISHED BY RECEIVED BY RELINQUISHED BY RECEIVED BY TURNAROUND REPORT REQUIREMENTS <br /> REQUIREMENTS X I. Routine Report <br /> Signature Signature Signature Signature 24 hr _49 fit -5 day Il. Report(includes DUP,MS <br /> X Standard(-1015 working days) MSD,as required,may be <br /> Printed Name Printed Name Printed Name Printed Name Provide Verbal Prelbrdimy Results charged as samples) <br /> Provide FAX Prelindrwry Results III.Data Validation Report <br /> Film Firm Firm Firm Requested Report Date: (includes All Raw Data) <br /> X RWQCB <br /> Date/Time Date/Time Date/Time Date/Time (MDLs/PQLs/TRACE# <br /> RELINQUISHED BY RECEIVED BY Special Instructions/Comments: Container Types Key: <br /> REFER TO Table VI ATTACHED for 5-YR Parameters. BC Labs-Tina Green 40 ml VOA: 1 <br /> Signature Signature 4100 Atlas Court 250 ml LPE: 2 <br /> Please report MDLs,PQLs and Trace. Bakersfield,Ca 93308 500 ml LPE: 3 <br /> Printed Name Printed Name Nitrate-Nitrogen has a 48-hr hold time. 661-327-4911/Fx:327-1918 1 liter HDPE: 4 <br /> Metals: Ca,Mg,K,No,Al,Sb,Ba,Be,Cd,Cr,Co, Ship via UPS Acct 965376 500 ml glass: 5 <br /> Firm Firm Cu,Ag,Sn,V,Zn,Fe,Mn,As,Pb,Hg,Ni,Se,Tl Field Support: Peter Bins 1 liter glass: 6 <br /> EDDs to<+usan.waterman@shawgrp.com> (408)391-2942 2x6 s/s ring: 7 <br /> Date/Time Date/Time glass jar: 8 <br />