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Shaw Environmental CHAIN OF CUSTODY I LABORATORY ANALYSIS REQUEST FORM Page_of <br /> 1326 North Market Boulevard Sacramento CA 95834 P.O.No: Direct Bill to the County <br /> Project Name: Harney Lane Landfill,San Joaquin County Lab: CAS,Simi Valle <br /> Project No.: 791290/00004000 An— R nested <br /> Report to: Sheila Richgels <br /> Company: Shaw Environmental w <br /> Address: 1326 North Market Boulevard <br /> ri o5 <br /> Sacramento,CA 95834 0 a <br /> Phone, (916)565-4327 / FAX: (916)565-4356 6 0 A <br /> Samplers Signature. <br /> U z O <br /> A � <br /> E~ample AB REMARKS <br /> ample 4 4 <br /> I.D. Date Time I.D. Matrix NP H2SO4 Container Types <br /> S-1 water 2 Preservations <br /> 1 1 <br /> S-2 water 2 1 1 <br /> RELINQUISHED BY RECEIVED BY RELIN SHED BY RECEIVED BY <br /> TURNAROUND REPORT REQUIREMENTS <br /> SignatureSignature ignature REQUIREMENTS X I. Routine Report <br /> Signature 24 nr _48 br _'day IL Report(includes DUP,MS <br /> Printed Name Printed Name Printed Name Staudazd(-1115 worldag days) MSD,as required,may be <br /> Printed Name PtOVW verbal t?xelirumary Results charged as samples) <br /> Firm Firm FumFirm NOVI&FAXPrAminaryResults M.Data Validation Report <br /> Requested Report Date: (includes All Raw Data) <br /> Date/Time ime Date/Time DatelTime X RWQCB <br /> RELINQUISHED BY RECEIVED BY Speciai Instructions/Comments: (IvIDLs/PQLs/TRACE#) <br /> Container Types Key: <br /> Signature Signature Columbia Analytical 40 mi VOA: 1 <br /> Please report MRL's,PQL's and Trace. 2655 Park Center Drive,Suite A <br /> Nitrate-Nitrogen has a 48-hr hold time. 250 ml LPE: 2 <br /> Printed Name Printed Name Simi Valley,Calif 93065 500 ml LPE• 3 <br /> 805-526-71611 Fk: 805-526-7270 1 liter HDPE: 4 <br /> Firm Firm Contact: Karen Ryan 500 ml glass: 5 <br /> 1 liter glass: 6 <br /> Datelt ime DatefTitne Ship UPS Acct 9653E1 2x6 s/s ring: 7 <br /> glasslar: 8 <br />