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CHAIN OF CUSTODY/LABORATORY ANALYSIS REQUEST FORM Page_of_ <br /> Shaw Environmental PO Number: Direct Bill to San Joaquin County <br /> 1326 North Market Boulevard SacramentoCA 95834 Lab: CAS,Simi Valle <br /> Project Name: Harney Lane Landfill,San Joaquin County An sis Requested <br /> Project No.: 791290 (Surface Water) <br /> Report to: Sheila Richgels <br /> <sheila-richgels®shawgrp.conv <br /> Company: Shaw Environmental <br /> o <br /> Address: 1326 North Market Boulevard U <br /> Sacramento,CA 95834 c o <br /> Dir Ph: (916)565-4327 / FAX: (916)565-4356 .46 <br /> Sampler's Signature: z A REMARKS <br /> ample LAB Samplee 3 125m1 Container Types <br /> I.D. Date Time I.D. Matrix NP NPeservati� ons <br /> S-1 water 2 1 1 <br /> S-2 water 2 1 1 <br /> RELINQUISHED BY REBY RELINQUISHED BY RECEIVED BY TURNAROUND REPORT REQUIILEMENTS <br /> REQUIREMENTS X I. Routine Report <br /> Signature ignature Signature Signature 2t Lr 48br 5 day H. Report(-dudes DUP,MS <br /> Staadazd(-10.15 working days) MSD,as required,maybe <br /> Printed Name Printed Name Printed Name Printed Name Provide VerbatPraiimiaary Results charged as samples) <br /> ProvkiePAXPaliminaryResuus M Data Validation Report <br /> IF,rm Fim1 Firm Firm Requested Report Date: ('includes All Raw Data) <br /> X RWQCB <br /> D ime DateJl"m� Date/rim Date/i'ime (MDLs/PQLs/I'RACE#) <br /> FELINQUI5RM BY RECEIVED BY Special Instructions/Comments- Container Types Bey: <br /> Signature Signature Pleaseort MDLs P Columbia`Analytical 40 W VOA: 1 <br /> rep QLs,and Trace. 2655 Park Center Drive,Suite A 250 ml LPE: 2 <br /> Simi Valley,Calif 93065 500 ml LPE: 3 <br /> PFmted Nam Printed Name 805-526-7161/Fx: 805-526-7270 1 liter HDPE: 4 <br /> Contact: Karen Ryan 500 ml glass: 5 <br /> Firm FirmContact: <br /> liter glass: 6 <br /> EDDs to<Alsan vktenhan@Aawgtp.corii:� Ship UPS Acct 9653E1 2x6 s/s ring: 7 <br /> Datef ime Date/Tim <br /> glass jar: 8 <br />