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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 /> i ' <br /> 1326 North Market Boulevard,Sacramento,CA 95834 Lab: CAS,Simi Valley <br /> Project Name: Harney Lane Landfill,San Joaquin County Anal is-Requested <br /> Project Number: 791290(Ground Water) <br /> Report to: Sheila Richgels <br /> <sheila.richgels@shawgrp.conv a <br /> Company: Shaw Environmental <br /> Address: 1326 North Market Boulevard U n <br /> Sacramento,CA 95834 0 o <br /> Dir Ph: (916)565-4327 / FAX: (916) 65-43 6 U <br /> Sampler's Signature: do <br /> Sample REMARKS <br /> P LAB Sample " 1 3 125n11 Container Types <br /> I.D. Date Time I.D. Matrix Hcl NP NP Preservations <br /> MW-1 i-t0 npo water 3 <br /> MW-2 '-_1 water 5 3 1 1 <br /> MW-3 11 <br /> tb water 5 3 1 1 <br /> MW-4 1D water 5 3 1 1 <br /> field Blank water 2 2 <br /> ri Blank water 2 2 <br /> RELINQUISHED BY RECEIVED BY @ RELINQUISHED BY TURNAROUND REPORT REQUIREMENTS <br /> 1111 REQUIREMENTS X L Routine Report <br /> S Signature Signature ignature 24 Lr 48 hr _5 day H. Report(includes DUP,MS <br /> 4 X Standard(-10.15 working days'Named MSD,as r y ma be <br /> L - <br /> fTy <br /> �� Punted Name Printed Name Priklted Name Provide VerbatPrel urinary Results charged as samples)Nlf/� t <br /> --J Provide FAX Preliminary Results III.Data Validation Report <br /> Firm F1tm F Requested Report Date: (includes All Raw Data) <br /> t X RWQCB <br /> Datetrime i-io-U Date/Time Date/Time Datgrrirne 01 DLs/PQLs/IRACE#) <br /> RELINQUISHED BY RECEIVED BY Special instructions/comments: Container Types Key: <br /> Columbia Analytical' 40 ml VOA: 1 <br /> Signature Signature Please report MDLs,PQLs,and Trace. 2655 Park Center Drive,Suite A 250 nil LPE: 2 <br /> Printed Simi Valley,Calif 93065 500 nilLPE: 3 <br /> Name Name 805-526-7161/Pa: 805-526-7270 1 liter HDPE: 4 <br /> Firn1 FinnContact: Karen Ryan 500 ml glass: 5 <br /> 1 liter glass: 6 <br /> ED <br /> Ds to<susan.waterman@shawgrp.com> Ship UPS Acct 9653E1 2x6 s/s ring: 7 <br /> Date rime Date rime <br /> glass jar: 8 <br />