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MMMMM <br /> CHAIN OF CUSTODY/LABORATORY ANALYSIS REQUEST FORM Page—of_ <br /> Shaw Environmental PQ Number: Direct Bill to San Joaquin County <br /> 1326 North Market Boulevard Sacramento CA 95834 Lab: CAS,Simi Valle <br /> Project Name: Harney Lane Landfill,San Joaquin County alysis Requested <br /> Project No.: 124593 (Surface Water) <br /> Report to: Sheila Richgels <br /> <sheila.richgels@shawgrp.conv a <br /> Company: Shaw Environmental <br /> 0 <br /> Address: 1326 North Market Boulevard U <br /> Sacramento,CA 95834 6 <br /> Dir Pb: (916)565-4327 / FAX: (916)565-4356 <br /> Sampler's Signature: REMARKS <br /> ample LAB Sample 3 125m1 tamer Types <br /> I.D. Date Time I.D. Matrix NP NP p , <br /> S-1 water 2 1 1 <br /> ations <br /> S-2 water 2 1 1 <br /> 16.0 <br /> /07 <br /> RELINQUISHED BY RECE RELINQUISHED BY RECEIVED BY TURNAROUND REPORT REQUIREMENTS <br /> REQUIREMENTS X I. Routine Report <br /> Signature Sipature Signature Signature uhr 48hr 5 day H. Report(includes DUP,MS <br /> Printed Name Printed Name Printed Name Printed Name <br /> stmdatd(-10-15 working days) MSD,as required,may be <br /> Provide vwbalPcelim my Results charged as samples) <br /> Finn Fri Firm <br /> PmHde PAXPrelimmazy Results IIL Data Validation Report <br /> RequestedlteportDate: (includes All Raw Data) <br /> Datdnme Dateirime Datelritne rx <br /> RWQCB <br /> RELINUISHED BY DateJrime (MDLs/PQLs/fRAt� <br /> Q RECEIVED BY Special InstructionsfComments: Container Types Bey: <br /> Columbia Analytical 40 ml VOA: 1 <br /> Signature Signature Please report MDLs,PQLs,and Trace. 2655 Park Center Drive,Suite A 250 ml LPE: 2 <br /> Simi Valley,Calif 93065 500 ml LPE: 3 <br /> Printed Name Punted Name 805-526-7161/Fx: 805-526-7270 I liter HDPE: 4 <br /> Finn Firm Contact: Karen Ryan 500 Ml glass: 5 <br /> 1 l liter glass: 6 <br /> EDDs to<susan watermanQshawgrp.corru Ship UPS Acct%53E1 2x6 s/s ring: 7 <br /> Date/time Date rime <br /> 9lass jar. 8 <br />