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CHAIN OF CUSTODY/LABORATORY ANALYSIS REQUEST FORM Page—of_ <br /> Shaw Environmental / o ���-2 PO Number: Direct Bill to San Joaquin County <br /> 1326 North Market Boulevard Sacramento CA 95834 Lab: CAS,Simi Vatte <br /> Project Name: Harney Lane Landfill,San Joaquin County An is Requested <br /> Project Number: 124593(Ground Water) <br /> Report to: Sheila Richgels <br /> <sheila.richgels0shawgrp.com> g <br /> Company. Shaw Environmental <br /> Address: 1326 North Market Boulevard U .fl <br /> Sacramento,CA 95834 c <br /> Dir Ph: (916)5654327 / F : (916)56 56 <br /> Sampler's Signature: REMARKS <br /> ample ZQoample F 1 3 125mt Container T <br /> I.D. Date Time I.D. Matrix HCL NP NP Preservations <br /> MW-1 v) z water 5 3 1 1 <br /> MW-2 U'-3 2 water 5 3 1 1 <br /> MW-3 1031 water 5 3 1 1 <br /> MW4 to water 5 3 1 1 <br /> Field Blank toln water 2 2 <br /> Trip Blank water 2 2 <br /> RELINQUISHED BY RECEIVED BY RELINQUISHEDBYRECIIVE TURNAROUND REPORT REQUIREMENTS <br /> PIS REQUIREMENTS X L Routine Report <br /> SI Signature Signature S* lure:. ; sant 48hr s day II. Repott(adudes DUP,NLS <br /> X smeaW(aarsv,«xmgdsy:) MSD,as required,may be <br /> Pri Nates Printed Name Printed Nara Printed Name Pmvide Verbal Preliminw R.=Ib charged as samples) <br /> t.7N o Pfovi&PAXPieft®azyReaehs III.Data Validation Report <br /> F-S#Jftj '> Firm Firm Fa 11 RequeatedRepwDate: (includes All Raw Data) <br /> r� L X RWQCB <br /> Datdrima Z%* Date/fime Date;Titne Datelrime (MDL 2 RA <br /> RELINQUISHED BY RECEIVED BY Special LtatructionalCommentst Container Types Key: <br /> Columbia Analytical 40 rill VOA: 1 <br /> Signature Signature Please report MDLs,PQLs,and Trace. 2655 Park Center Drive,Suite A 250 mi LPE: 2 <br /> Simi Valley,Calif 93065 500 ml LPH- 3 <br /> Printed Name Printed Name 805-526-7161 Ift 805-526-7270 1 liter HDPE: 4 <br /> Film Film <br /> Contact:Karen Ryan 500 ml glass: 5 <br /> l liter glass: 6 <br /> EDDs to csusan.watcrmau@shawgrp.com> Ship UPS Acct 9653E1 2xsr ting: 7 <br /> Data(rime Date me <br /> glans jar: 8 <br />