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Shaw Environmental CHAIN OF CUSTODY/LABORATORY ANALYSIS REQUEST FORM Page <br /> —of- <br /> 13-26 <br /> of_1326 North Market Boulevard,Sacramento CA 95834 P.O.# erect Bill to San Joaquin County <br /> Project Name:North County Landfill,San Joaquin County Lab: CAS,Canoga Park,Ca <br /> Project Number: 791288 (Ground Water) AnalysisRequested <br /> Report to: Sheila Richgels <br /> <Sheila.Richgels@Shawgrp.com> r _ <br /> Company. Shaw Environmental <br /> Address: 1326 North Market Boulevard o <br /> U <br /> Sacramento, CA 95834 w„ W <br /> (916)565-4356 <br /> Dir Ph: (916)565-4327 / FAX: c <br /> � <br /> ,o 00 <br /> Sampler's Signature: Z <br /> Sample LAB Sample 1 REMARKS <br /> I.D. Date Time I.D. Matrix HCl conumer Types <br /> ons <br /> G-4 ab LL water 3 3 <br /> G-5 water 3 3 <br /> G-6 water 3 3 <br /> Field Blank water 2 2 <br /> Trip Blank water 2 2 <br /> U' <br /> P:F <br /> RELINQUISHED BY RECEIVED BYRII INQUISHED BY RE TURNAROUND <br /> PIS REPORT REQUIREMENTS <br /> REQUIREMENTS X L R6utine Report <br /> Si a Si nature <br /> g Signature Stpnature t _ ` 1 24 yr 48 hr 5 day H. Report(includes DUP,MS <br /> ft ril��-e-t CL`►-t X Standard(-10.15 working days) MSD,as required,may be <br /> N Printed Name Printed Name <br /> Printed Name Provide Verbal Preliminary Resells charged as samples) <br /> Provide FAX Preliminary Results III.Data Validation Report <br /> Fulf, Flan <br /> Firm <br /> r Requested Report Date: (includes All Raw Data) <br /> t� X RWQCB <br /> Date/Time -1terOlo Date/Tim Date/Time Date/Time <br /> RELINQUISHED BY RECEIVED BY sPQLs/TRACE#)Silnnommens: <br /> Container Types Key: r G+ <br /> mw <br /> Report MDIs,PQLs,and Trace. Cohunbia Analytical 40 ml VOA: 1 <br /> Signature Signature 8030 Remmet Avenue,Suite 2 250 ml LPE: 2 <br /> Canoga Park,Calif 91304 500 ml LPE: 3 <br />'rimed Name Printed Name 818-316-0904/Fk:818-316-0896 1 liter.HDPE: 4 <br /> Firm <br /> Firm <br /> Lab Contact: Karen Ryan 500 ml glass: 5 <br /> 1 liter glass: 6 <br /> EDDs to<susanmaterman@shawgrp.conu Ship UPS Acct 9653BI 1 li er ' 7 <br />)ate/Time Date/Time �. <br />