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Shaw Environmental CHAIN OF CUSTODY LABORATORY ANALYSIS REQUEST FORM Page_Of <br /> 1326 North Market Boole Sacramento CA 95834 P•O.# Feet Bill to San Joaquin County <br /> Project Name:North County Landfill,San Joaquin County Lab: CAS,CpM Park,Ca <br /> Project Number: 791288 (Ground Fater) Requested <br /> Report to:Sheila Richgels <br /> <Sheila.Richgels@Shawgrp.com> 3 T <br /> Company: Shaw Environmental <br /> Address: 1326 North arket Boulevard 00 <br /> M <br /> Sacramento, CA 95834 4; as <br /> Dir Ph: (916)565-4327 / FAX: (916)565-4356 <br /> C14 <br /> Sampler's Signature: w <br /> Sample LAB Sample 1 REMARKS <br /> I.D. Date Time I.D. Matrix HCl ContafnerTypes <br /> 11 A <br /> G-4 $ab ZL water 3 3 <br /> G-5 1 water 3 3 <br /> G-6 water 3 3 <br /> Field Blank . t-%A water 2 2 <br /> Trip Blank 140 4-31A water 2 2 <br /> RELINQUISHED BY RECEIVED BY RM WQUISMM BY RE Q. TURNAROUND REP0.RT=. QunumnwTs <br /> PIS Si <br /> REQUIREMENTS X I. Routine Report <br /> Signature, Signature 'gnature 1 24 hr 4s hr 5 day 11 Report(includes DUP,MS <br /> qMrNe��l f X Stan (-10-15 wosttng darn) MSD,as required,may be <br /> Punted Name Printed Name Printed Name �„ A _ Acovide ve*d Preliminary Results charged as samples) <br /> Fit r <br /> (�_3 PfoyideFAX PrelimtnaryResults UL Data ValidationReport <br /> � Firm ^` Requested Reporti)ate: (includes All Raw Data) <br /> t� B <br /> Date/rime -1�{Xo Date/Imie DateJfime DateJfime X RWQCRWQCPQLs/IRACE#) <br /> RELINQUISHED BY RECEIVED BY Special hatr tctions/Comments: <br /> Container Types Key: <br /> RepM <br /> ort DLs,PQLs,and Trace. Columbia Analytical 40 ml VOA: i <br /> Signature Signature 8030 Remmet Avenue,Suite 2 250 ml LPE: 2 <br /> Canoga Park,Calif 91304 500 ml LPE: 3 <br /> Printed Naaxi Printed Name 818-316-0904/Fx:818-316-0896 1 liter HDPE: 4 <br /> Film F� <br /> Lab Contact: Karen Ryan 500 ml glass: 5 <br /> 1 liter glass: 6 <br /> EDDs to•csnsan.watermssn0shawgrp.com> Shtp ZIPS Acct 9653E1 <br /> Daterrim2x6 s/sring: 7 <br /> a I�� <br /> glassjar: 8 <br />