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CHAIN OF CUSTODY /LABORATORY.ANALYSIS REQUEST FORM Page —of_ <br />Shaw Environmental /^j % P.O. No: Direct Bill San Joaquin County <br />1326 North Market RnnlPvarri Care �mnr�4n 11 A OL4'2A C T ! ) ^ : ( f r� <br />-___. - - - <br />Project Name: Foothill Landfill, San Joaquin County <br />-- �•.•. - <br />Analysis <br />1+4U. <br />Requested <br />1.t1D�il1m, vaney <br />Project Number: 12459ITLeachate Module) <br />Report to: Sheila Richgels <br />c <br />Company. Shaw Environmental <br />Address: 1326 North Market Boulevard <br />Sacramento, CA 95834 <br />U. <br />Dir Ph: (916) 565-4327 / F (91 565-43 6 0 .0 <br />N <br />o <br />Sampler's Signature: <br />U <br />z <br />y <br />coi <br />04 <br />REMARKS <br />Sample Sample <br />Liter <br />125ml <br />5001111 <br />VOA <br />Container Types <br />I.D. Date Time I.D. Matrix <br />NP <br />NP <br />HNO3 <br />HCl <br />Preservations <br />1-01 1:11 <br />water 6 <br />1 <br />1 <br />1. <br />3 <br />RELINQUISHED BY RECEIVED BY <br />RELINQUISHED BY _ <br />REC M <br />B <br />TURNAROUND <br />REPORT REQUIREMENTS <br />Up S <br />REQUIREMENTS <br />24 nr 48 Lr 5 day <br />X <br />I. Routine Report <br />H. Report (includes DUP, MS <br />Signature <br />Ll"_ <br />Signature <br />Signature <br />JNa2me� <br />�_ovin;r <br />X s�enaard (»tats woddag days) <br />Provide VabaiPielminaryResults <br />MSD, as required, may be <br />charged as-nVIes) <br />j Printed Name <br />Printed Name <br />Printed Name <br />ProviaePARProumioaryxesvas <br />Requested RepoaDate: <br />HI. Data Validation Report <br />(includes All Raw Data) <br />Firm <br />c"d tom•+ <br />um <br />Firm <br />C� <br />X <br />RWQCB <br />Datefrime c. =CJ Datefrime <br />Date/Time <br />Datefritiie <br />RELINQUISHED BY RECEIVED BY <br />Special Instructions/Comments: <br />Container Types Key: <br />Please report MDLs, PQLs and Trace. <br />Columbia Analytical; <br />2655 Park Center Drive, Suite A <br />40 ml VOA: <br />250 ml LPE: <br />1 <br />2 <br />Signature Signature <br />Nitrate -Nitrogen has a 48 -hr <br />hold time. <br />Simi Valley, CA 93065 <br />805-526-7161/ Fx 805-526-7270 <br />500 n -d LPE: <br />1 liter HDPE: <br />3 <br />4 <br />Printed Name Printed Name <br />Contact - <br />Contact: Karen Ryan <br />Acct 9653131 <br />500 ml glass: <br />1 liter glass: <br />5 <br />6 <br />Fma Firm. <br />EDDs to <susan.watemkan@shawg:rp <br />com> <br />2x6 s/s ring: <br />8.1a= <br />7 <br />8 <br />Date/rime Date/Time <br />