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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 />1326 North Market Boulevard_ Sncramentn_ CA 95R3d "Dbq no I l7? I ah- VAC Cimi Vallav <br />Project Name: Foothill Landfill, San Joaquin County <br />Project Number: 124591 (Leachate Module) <br />Report to: Sheila Richgels y <br />Company: Shaw Environmental <br />Address: 1326 North Market Boulevard w <br />Sacramento, CA 95834 U <br />Dir Ph: (916) 565-4327 / FAM: kJ 01 565-43 6 8 0 <br />Sampler's Signature: <br />v <br />o <br />c <br />to. <br />U <br />Analysis <br />a <br />Requested <br />REMARKS <br />Sample LAB ample Liter <br />I.D. Date Time I.D. Matrix NP <br />125m1 <br />500m1 <br />VOA <br />Container Types <br />NP <br />HNO3 <br />HCl <br />Preservations <br />L-01 water 6 1 <br />1 <br />1. <br />3 <br />RELINQUISHED BY RECEIVED BY i <br />V �� <br />RELINQUISHED BY <br />PIS <br />Signature <br />Printed Name <br />Firm <br />Datefrime <br />REC <br />Signature <br />Printed Name <br />C <br />Firm <br />ao <br />Daw Tfihe <br />BL TURNAROUND <br />REQUIREMENTS <br />24br 48 br 5 day <br />standard (-10-15 working days) <br />Provide verbal Preliminary Results <br />Provide FAX Preliminary Results <br />Requested Report nate: <br />REPORT <br />X <br />X <br />REQUIREMENTS <br />I. Routine Report <br />H. Report (includes DUP, MS <br />MSD, as required, may be <br />charged as samples) <br />HI. Data Validation Report <br />(includes All Raw Data) <br />RWQCB <br />(MDLs/PQLs/TRACE#) <br />Signa Signature <br />Pri Name tl ' Printed Name <br />love, ed <br />Firm <br />Datelrime 1,3J.22 Date/Tiine <br />RELINQUISHED BY RECEIVED BY <br />Special Instmetions/Comments: <br />Please report MDLs, PQLs and Trace. <br />Nitrate -Nitrogen has a 48 -hr hold time. <br />EDDs to <susan.waterman@shawgrp.com> <br />. .. `. , . <br />I <br />. `. <br />.. <br />Columbia Analytical <br />2655 Park Center Drive, Suite A <br />Simi Valley, CA 93065 <br />805-526-7161/ Fx 805-526-7270 <br />Contact: Karen Ryan <br />UPS Acct 9653131 <br />Container Types Key: <br />40 ml VOA: <br />250 ml LPE. <br />500 ml LPE. <br />1 liter HDPE: <br />500 ml glass: <br />1 liter glass: <br />2x6 s/s ring: <br />glass jar: <br />1 <br />2 <br />3 <br />4 <br />5 <br />6 <br />7 <br />8 <br />Signature Signature <br />Printed Name Printed Name <br />FirmFirm <br />DatelTime Date/Time <br />