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CHAIN OF CUSTODY/LABORATORY ANALYSIS REQUEST FORM Page_of_ <br /> Shaw Environmental / P.O.No: Direct Bili to the County <br /> 1326 North Market Boulevar Sacrament CA 9583$ I.ab: CAS,Simi Valle <br /> Project Name: Harney Lane Landfill,San Joaquin County Analysis Requested <br /> Project Number: 791290/00004000 <br /> Report to: Sheila Richgels •�° <br /> Company: Shaw Environmental v - <br /> Address: 1326 North Market Boulevard <br /> CIO <br /> Sacramento,CA 95834 U �+ <br /> .o <br /> Phone: (916)565-4327 / FAX; (9 6)565-4356 w .8 <br /> ko <br /> Sampler's Signature. d <br /> amplez REMARKS <br /> I.D. Date Time I.D. Matrix 4 3 1 Contai-Types <br /> MW-1 "4i7" 1 NP H2So4 HCI Preservations <br /> ltbt a water 5 <br /> 1 3 <br /> MW-2 pat' water 5 1 1 3 <br /> MW-3 C1 22 ITwater 5 1 1 3 <br /> MW-4 water 5 1 1 3 <br /> Field Blank ^j water, 2 2 <br /> Blank h2 water 2 2 <br /> RELINQUISHED BY "CUM BY RELINQUISHED BY Y TURNAROUND <br /> REPORT REQUIREMENTS <br /> REQUIREMENTS <br /> Si a Signature Signature X L Routine Repat <br /> I g ignature �anr gsnr _sear II. Report(includes DUP,MS <br /> X Standard(-1415 wodaog days) MSD,as required,may be <br /> Name/' Printed Name Printed Name Printed Name <br /> rrovlae v«batrronmisary Reem:s charged as samples) <br /> F � Firm CASP+°ode FnXYretamtoary Rcsuus III Data Validation Report <br /> Firm Requested ReportDate: <br /> f - Cad's All Raw Data) <br /> DatelTime i X RWQCB <br /> O f •::t.> Datell'ima DateJfitns Da ia� <br /> RELINQUISHED BY RECEIVED BY Special InstructlotlslCotmnents: (MDLsIPQLslfRACE#) <br /> Container Types Key. <br /> Columbia Analytical 40 ml VOA: 1 <br /> Signature Signature Please report NRL's,PQL's and Trnce <br /> 2655 Park Center Drive,Suite A 250 ml LPE: 2 <br /> Nitrate-Nitrogen has a 48-hr hold thne. Simi Valley,Calif 93065 500 ml LPE: 3 <br /> Printed Name Printed Name <br /> 805-526-7161 IFx: 805-526-7270 1 liter HDPE: 4 <br /> Firm Firm ContactKaren Ryan 500 ml glass: 5 <br /> 1 liter glass: 6 <br /> Datefrime Wwaime Ship UPS Acct 9653E1 2x6 s/s ring: 7 <br /> 11=jar: 8 <br />