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CHAIN OF CUSTODY/LABORATORY ANALYSIS REQUEST FORM Page_of_ <br /> Shaw Environmental ,--� `� Pp Number: Direct Bill to San Joaquin County <br /> 1326 North Market Boulevar Sacrament CA 95834 .. 1 Lab: CAS,Sime Valle <br /> Project Name: Harney Lane Landfill,San Joaquin County Anal Requested <br /> Project Number: 791290(Ground Water) <br /> Report to: Sheila Richgels <br /> <sheila.richgels Qshawgrp.com> <br /> Company: Shaw Environmental �a <br /> Address: 1326 North Market Boulevard <br /> Sacramento,CA 95834 c <br /> Dir Ph: (916)565.4327 J F : (916)$654356 U <br /> Sampler's Signature: a <br /> z w REMARKS <br /> Sample ample ,.. 1 3 125m1 Container Tye <br /> I.D. Date ElmD. Matrix xca NP NP Preservations <br /> MW-1 1-t0-b water 3 I. 1 <br /> MW-2 water 5 3" water 5 3 1 1 <br /> W-4 tett' water 5 3 1 1 <br /> Field Blank water 2 2 <br /> Tri Blank water 2 2 <br /> RELINQUISHED BY RECEIVED BYPIS RELINQUISHED BYRE Y TURNAROUND REPORT REQUIREMENTS <br /> REQUIREMENTS X L Routine Report <br /> S <br /> Signature ire ignatute u>ff _48 nr _s aay IL Report(includes DM ms <br /> i X sena.;(--s weedng days) MSD,as required,maybe <br /> Pr"N Printed Name Printed Nanta <br /> U�1_. N /yICO._... Printed Name � Ymvwe ve�nst rettmtnay ltesuua charged as files) <br /> L �C!(7 1 - PrmAe PAX PnRmkwy Reautls III.Data Validation Report <br /> FimtGerdes All Raw Data) <br /> SH+w� �Z Firm Firm l? ;.. . RegseaeaReporiDare: <br /> Datemim I-Ip-cD j3'at: Daterrime. Data/I'n a Da X B <br /> RWRWQCQCPQLsrtRACi <br /> RELINQUISHED BY RECEIVED BY Speetal Insh ucttorWComments: Contaiaes Types Key: <br /> IRrinted Columbia Analytical 40 ml VOA: 1 <br /> Signature Signature Please report MDLs,PQLs,and Trace. 2655 Park Center Drive,Suite A 250 ml LPE. 2 <br /> Simi Valley,Calif 93065 500 ml LPB: 3 <br /> Nam Printed N 805-526-7161 IFx: 805-526-7270 1 titer HDPE: 4 <br /> Contact:Karen Ryan 500 ml grass: 5 <br /> Firm Firm <br /> 1 liter glass: 6 <br /> LEDDs to<wsan Waterman.@shawgrp.com> Ship UPS Acct 9653E1 2x6 sh ring: 9 <br /> Daternma iDatdTimo <br /> glassjar: 8 <br />