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CHAIN OF CUSTODY LABORATORY ANALYSIS REQUEST FORM Page_of_ <br /> Shaw Environmental / P.O.No: Direct Bill to the County <br /> 1326 North Market Boulevard,Sacramento CA 95834 / Lab: GAS,Sirirn""Valley <br /> Project Name;.Harney Lane Land�Yi 111.San Joaquin County AnalysisRequested <br /> Project Number: 791290/00004000 <br /> Report to: Sheila Richgels <br /> Company: Shaw Environmental i <br /> S .— <br /> Address: 1326 North Market Boulevard �� � <br /> o <br /> Sacramento, CA 95834 c-, > <br /> 8 a <br /> Phone: (916)565-4327 / FAX: (9A16)565-4356 0 0 <br /> � o Z <br /> Sampler's Signature: CdU <br /> REMARKS <br /> Sample LAB Sample 4 3 1 Container T <br /> I.D. Date Time I.D. Matrix Types <br /> NP H2So4 HCl Preservations <br /> MW-1 'lal E142- water. 5 1 1 3 <br /> MW-2 water 5 1 1 3 <br /> MW-3 01 2-L water 5 1 1 3 <br /> MW-4 water 5 1 1 3 <br /> field Blank 5water 2 <br /> 2 <br /> drip Blank Nil water 2 <br /> 2 <br /> RELINQUISHED BY RECEIVED BY RELINQUISHED BY &�REAY TURNAROUND REPORT REQUIREMENTS <br /> REQUIREMENTS X I. Routine Report <br /> Sig a Signature Signature gnature 24 hr _4anr _5day IL Report(includes DUP,MS <br /> X standar=(-1a15workngdays) MSD,as required,may be <br /> Name Printed Name Printed Name Printed Name Provide verbal Prelftnhary Results charged as samples) <br /> Provide FAX PreHmiwy Results III.Data Validation Report <br /> Fi Firm Firm <br /> .. � � -Pirm - Requested Report Date: <br /> �(� r .� � {includes All Raw Data) <br /> 4 X RWQCB <br /> Date/Time. /Q-16-4;, Date/Time DatwTime Ixtefrime (MDLs/PQLs/TRACE#) <br /> RELINQUISHED BY RECEIVED BY Special Instructions/Comments: Container Types Key: <br /> Columbia Andytical 40 nil VOA: 1 <br /> Signature Signature Please report MRL's,PQL's and Trace. 2655 Park Ceiter Drive,Suite A 250 ml LPE: 2 <br /> "�mtrogenhas a 484i.oldthhC Simi Valley,Calif 93065 500 ml LPE: 3 <br /> Printed Name Printed Name 805-526-7161/Rt: 805-526-7270 1 liter HDPE: 4 <br /> Fum FinnContact: Karel Ryan 500 ml glass: 5 <br /> 1 liter glass: 6 <br /> Ship-UPS Acit 9653EI 2x6 s/s ring: 7 <br /> Date/Time Date/Time <br /> glass jar: 11 <br />