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CHAIN OF CUSTODY / LABORATORY ANALYSIS REQUEST FORM Page — of _ <br />Shaw Environmental P.O. No: Direct Bill San Joaquin County <br />9326 North Market Ronlevard_ CnrrnniPntn. VA tlGit' A T _L. A <br />Project Name: Foothill Landfill, San Joaquin County <br />� <br />L(LV. VAV, Vlllal ♦ fiLLC <br />Analysis Requested <br />Project Number: 124591 (Ground Water) <br />Report to: Sheila Richgels <br />o <br />Company: Shaw Environmental <br />cq <br />w <br />Address: 1326 North Market Boulevard <br />N' <br />U <br />Sacramento, CA 95834 <br />U <br />Z <br />Dir Ph: (916) 565-4327 / F 916) SPS -4356 <br />0 <br />z <br />!Samplers <br />Signature: <br />O <br />A <br />U <br />b <br />Z <br />RRMARK$ <br />Sample LAB Sample <br />VOA <br />Liter <br />125ml <br />500ml <br />Container Types <br />I.D. Date Time I.D. Matrix HCl <br />NP <br />NP <br />HNO3 <br />Preservations <br />MW -1 �- 1 i� / <br />water 6 3 <br />1 <br />1 <br />1 <br />MW -2R <br />water 6 3 <br />1 <br />1 <br />1 <br />MW -3 ,ace <br />water 6 3 <br />1 <br />1 <br />1 <br />LW -1 i <br />water 6 3 <br />1 <br />1 <br />1 <br />field Blank Jul water 2 2 <br />ri Blank MA <br />water 2 2 <br />RELINQUISHED BY RECEIVED <br />RELINQUISHED BY <br />RE <br />TURNAROUND <br />REPORT REQUIREMENTS <br />Signature <br />gnature <br />r <br />REQUIREMENTS <br />24 hr 48 hr 5 day <br />X <br />L Routine Report <br />II. Report (includes DUP, MS <br />Signature <br />Signal Lfl <br />Printed Name <br />notlaiz, <br />Printed Nam_. <br />X <br />standard (-10.15 working days) <br />Provide Verbal Preliminary Results <br />MSD, as required, may be <br />charged as samples) <br />N Printed Name <br />a H <br />Firm <br />Date/Time <br />Firm -I <br />Date/Time <br />kj <br />Provide FAX Preliminary Results <br />Requested Report Date: <br />X <br />III. Data Validation Report <br />(includes All Raw Data) <br />RWQCB <br />(NIDLs/PQLs/TRACE#) <br />Firilt ' Firm <br />Date/rime j.Q'? SlO Date/Time <br />RELINQUISHED BY RECEIVED BY <br />Special Instructions/Comments: <br />Container Types Key: <br />Please report MDLs, PQLs <br />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 <br />time. <br />Simi Valley, CA 93065 <br />805-526-7161/ Fx 805-526-7270 <br />500 mi LPE: <br />1 liter HDPE: <br />3 <br />4 <br />Printed Name Printed Name <br />Contact: Karen Ryan <br />UPS Acct 9653E1 <br />500 ml glass: <br />1 liter glass: <br />5 <br />6 <br />Firm Firm <br />EDDs to <susan.waterman@shawgrp.com> <br />2x6 s/sring: <br />glass jar: <br />7 <br />8 <br />Daw`Tirne Date/Time <br />G <br />i♦ � ® � � A 1� il♦ ® � � iii � i� ill♦ � ® i� <br />