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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 /> Lab: BC Labs,Bakersfield <br /> 1326 North Market Boulevard,Sacramento,CA 95834 <br /> Project Name:Foothill Landfill,San Joaquin County Analysis Requested <br /> Project Number: 124591 (Resample 3&4 for 8270s) <br /> Report to: Sheila Richgels g <br /> Company: Shaw Environmental <br /> Address: 1326 North Market Boulevard 4 _ <br /> Sacramento,CA 95834 U >+ 0 P. <br /> Dir Ph: (916)5654327 1 FAX: (916)565-4356 o z Q a o <br /> o >, <br /> �] n U oo -t o Fc <br /> Sampler's Signature: N r> z REMARKS <br /> z <br /> sampf—e 2009 LAB Sample L.GIs ConlaincrTypes <br /> I.D. Date Time I.D. Matrix rvr Preservations <br /> MW-3 11-2- i� water 2 2 <br /> MW-4 1-Z- water 2 2 <br /> Rt'sLINQUISHED BY RECEIVED IIY RELINQUISIiED BY RECEIVED BY TURNAROUND REPORTREQUIREMENTS <br /> REQUIREMENTS X 1. Routine Report <br /> Si or- Signaut Signature Signature ±01v _tx it s day ]l. Report(includes DUP,MS <br /> X t.9endird 1-10.15 wotichig days) MSD,as required,nuty be <br /> P' t d Name.� Printed-am r Prim=cyozilinted Name Printed Name <br /> Provide verbal Prcunwaery Results charged as samples) <br /> Vi V�/C7Tl ��� " �' Prrnide FAX PulinanaryResults 11I.Data Validation Report <br /> Firn Firm Finn Fimt Requeslad Relmn rAle (includes All Raw Data) <br /> X 12WQCB <br /> S j <br /> Date/Tilne )-Z^ d` n Dale/Timo °l a; Datc/Time Date/Timis (MDLs/PQ Conna40e inR Types <br /> Key: <br /> RELINQUISHED BY RECEIVED BY Special Instructinus/Connuettts; Typesypes <br /> BC I.atbs•Tina Cm-on40mi VOA: 1 <br /> Signature Signature Please report MDLs,PQLN and Trace. 4100 Atlas Court 250 ml LM 2 <br /> Bakersfield,Ca 93308 500 ml L.PE: 3 <br /> Printed Name Printed Name 661-327-4911/Fx:327.1918 l liter HDPE: 4 <br /> Ship via UPS Acct 965376 500 ml glass: 5 <br /> Firm Finn Field Support: Peter Bins 1 liter glass: 6 <br /> L'DDs to tsavau.watet•iiiait).slunvxrp.rom> (408)391.2942 2x6 s/s ring: 7 <br /> Date/Time Da+tc/Time glassjar 8 <br />