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CHAIN OF CUSTODY / LABORATORY ANALYSIS REQUEST FORM IPage _ of _ <br />Shaw Environmental P.O. No: Direct Bill San Joaquin County <br />1326 North Market Boui, card Sacramento CA 95834 / 0 / Uj�cl 1"� Lab: CAS, Simi Vallev <br />;1roject Name: Foothill Landfill, San Joaquin County <br />LAB <br />Date I Time I.D. <br />N <br />Matrix+` <br />, + �.'�,... <br />�&.0jeet Number' 124591 (Resamplx!) <br />1 <br />HCl <br />MW -1 <br />%GAO I� <br />water <br />Report t" Sheila Richgels <br />3 <br />MW -2R <br />1 liter HDPE: <br />C - apan) . Shaw Environmental <br />3 <br />3 <br />MW -3 <br />Address: 1326 North Market Boulevard <br />water <br />3 <br />Cq <br />Sacramento, CA 95834 <br />A <br />U <br />.a <br />3L►ir Ph: (916) 565-4327 / F (916) 565-4356 <br />,.,,TriD Blank <br />Lei <br />-�' <br />a~ <br />2 <br />2 <br />0 <br />Sampler's Signator.. <br />1 <br />aampilu <br />I.D. <br />LAB <br />Date I Time I.D. <br />N <br />Matrix+` <br />, + �.'�,... <br />VOA <br />1 <br />HCl <br />MW -1 <br />%GAO I� <br />water <br />3 <br />3 <br />MW -2R <br />1 liter HDPE: <br />water <br />3 <br />3 <br />MW -3 <br />UPS Acct 9653E1 <br />water <br />3 <br />3 <br />Field Blank <br />A <br />water <br />2 <br />2 <br />,.,,TriD Blank <br />Lei <br />water <br />2 <br />2 <br />r(ELINQUISIIED BY RECEIVED BY ^ REI <br />I <br />Si S:gilattire _..� � sign <br />LU <br />i Printed Name Print <br />all l <br />to <br />,LINQUISH[ED B' R' . <br />f Signature - . <br />Printed (wine riiuted N <br />_.4- <br />1 "Z-- L l <br />re <br />Name <br />.1st. "mcti�-5e_ <br />reporl <br />TURNAROUND <br />REQUIREMENTS <br />14hr 48br 5day <br />Standard (-10.15 working days) <br />Provide Verbal Preliminary Results <br />Provide FAX Preliminary Results <br />Requested Report Date: <br />:SPORT REQUIREMENTS <br />X I. Routine Report <br />®II. Report (includes DUP, MS <br />MSD, as required, may be <br />charged as samples) <br />Ill. Data Validation Report <br />(includes All Raw Data) <br />X RWQCB <br />Container Types Key: <br />Columbia Analytical <br />40 ml VOA: <br />1 <br />Trace. 2655 Park Center Drive, Suite A <br />250 ml LPE: <br />2 <br />Simi Valley, CA 93065 <br />500 ml LPE: <br />3 <br />805-526-7161/ Fx 805-526-7270 <br />1 liter HDPE: <br />4 <br />Contact: Karen Ryan <br />500 ml glass: <br />5 <br />UPS Acct 9653E1 <br />l liter glass: <br />6 <br />- rpxoln> <br />2x6 s/s ring: <br />7 <br />/ <br />42410 3 <br />glass jar: <br />8 <br />