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CHAIN OF CUSTODY / LABORATORY ANALYSIS REQUEST FORM Page _ of _ <br />Shaw Environmentaly^''� P.O. No: Direct Bill San Joaquin County <br />1326 North Market Rmilavnrll CarTa.r.o.,t.. t1 A oc4•t t �� //4-- <br />_ -- _ ___ _ _ __ <br />Project Name: Foothill Landfill, San Joaquin County <br />_ <br />• . �.- <br />. _ i ,. ,e- <br />Lafl. �l:H�j YII]f 5+aiie <br />Analysis <br />Requested <br />Project Number: 124591 (Groltud Fater) <br />Report to: Sheila Richgels <br />o <br />Company. Shaw Environmental <br />Address: 1326 North Market Boulevard <br />too° <br />U <br />Sacramento, CA 95834 <br />o <br />U <br />00 <br />Q <br />Dir Ph: (916) 565-4327 / F 916) 505-4356 <br />o <br />0 <br />0 <br />Sampler's Signature: <br />U <br />H <br />•c <br />z <br />> <br />qq <br />v' <br />as <br />Sample LAB <br />ample <br />= <br />VOA <br />E� <br />Liter <br />125m1 <br />5001111 <br />IREMARKS <br />I.D. Date Time I.D. Matrix IM <br />HCl <br />NP <br />ern <br />HNO3 <br />Container Types <br />Preservations <br />MW i j <br />-1 - i� <br />water <br />6 <br />3 <br />1 <br />1 <br />1 <br />MW -2R is <br />water <br />6 <br />3 <br />1 <br />1 <br />1. <br />MW -3 1a9B 0 <br />water <br />6 <br />3 <br />1 <br />1 <br />1 <br />LW -1 1257 <br />water <br />6 <br />3 <br />1 <br />1 <br />1 <br />Field Blank 116 <br />water <br />2 <br />2 <br />Tri Black ) <br />water <br />2 <br />2 <br />RELINQUISHED BY <br />RECEIVEDUPS <br />REL QUISHED BY <br />` ; <br />3tE <br />TURNAROUND REPORT REQUIREMENTS <br />Signature <br />Signature <br />- ti, <br />REQUIREMENTS X <br />u Lr 0-8 bf 5 day <br />I. Routine Report <br />H. Report (includes DUP, MS <br />Si a <br />Signature <br />- <br />jrst®daid <br />(_10-15 woddog days) <br />MSD, as required, maybe <br />N <br />Printed Name <br />n <br />Printed Name <br />Printed,Name <br />... _ :. <br />Provide VerbalFmI uina,y Results <br />charged as samples) <br />1 <br />Firm <br />Provide PAXPrelimmaty Results <br />Requested Report Date: <br />M. Data Validation Report <br />(includes All Raw Data) <br />DateJTime <br />0 <br />Date/Time: <br />to z� <br />tJ <br />X <br />RWQCB <br />l2IDLs/PQLs/fRACE#) <br />DaWrhw .QM, <br />Date/Time <br />REI INQ1IS11ED BY <br />RECEIVED BY <br />Special instructions/comments: <br />Container Types Bey: <br />Please report MDIs, PQIs and Trace. <br />2655 Park Center Wv-e,'Suite A <br />40 m1 VOA-- <br />250 ml LPE: <br />1 <br />2 <br />Signature <br />Signature <br />Nitrate -Nitrogen <br />has a 48 -hr <br />hold <br />time. <br />Simi Valley, CA 93065 <br />805-526-7161/Ik 805-526-7270 <br />500 ml LPE: <br />1 liter HDPE: <br />3 <br />4 <br />Printed Name <br />Printed Name <br />Contact: Karen Ryan <br />500 ml glass: <br />5 <br />Firm <br />F1>m <br />UisS.Acct 9653E1;: <br />1 liter glass: <br />6 <br />EDDs to <susanwaterman@shawgrpcom> <br />.2x6 s/s ring: <br />7 <br />Datelfm� <br />Date/Time <br />glass jar. <br />8 <br />