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CHAIN OF CUSTODY I LABORATORY ANALYSIS REQUEST FORM Page _ of _ <br />Shaw Environmentalj"�j / P.O. No. Direct Bill Saii Joaquin County <br />1326 North Market Rnttlevnr�i_ Sarramenfn f A tlCQ4d 1(19(,k) <br />/ (j� 9,9/,)�� t <br />Project Name: Foothill Landfill, San Joaquin County <br />Analysis <br />Recinested <br />Project Number: 791289 (Ground Water), <br />, <br />Report to: Sheila Richgels <br />Company: Shaw Environmental <br />o <br />Address: 1326 North Market Boulevard <br />Sacramento, CA 95834 <br />r. �° 00 <br />U <br />Dir Ph: (916) 565-4327 / FAX: (916) 565-4356 <br />c <br />o <br />.o <br />b <br />a <br />Sampler's Signature:t <br />j <br />v; <br />z <br />9 <br />z O <br />A <br />U <br />z,=. <br />2 <br />Eel <br />I <br />I IREMARKS <br />Sampleample <br />1 <br />4 <br />125m1 <br />Container Types <br />I.D. Date Time I.D. Matrix <br />HCl <br />NP <br />NP HNO3 <br />Preservations <br />MW -1 'j •a S® <br />water <br />6 <br />3 <br />1 <br />1 <br />1 <br />MW -2R '�`i� <br />water <br />6 <br />3 <br />1 <br />1 <br />1 <br />MW -3 <br />water <br />6 <br />3 <br />1 <br />1 <br />1 <br />1 <br />LW -1 <br />water <br />6 <br />3 <br />1 <br />1 <br />1 <br />Feld Blank 01A <br />water <br />2 <br />2 <br />'Trip Blank <br />water <br />2 <br />2 <br />RELINQUISHED BY RECEIVED BY <br />RELINQUISHED BY <br />REC <br />TURNAROUND REPORT REQUIREMENTS <br />U <br />Signatttre <br />REQUIREMENTS X <br />24 b 48 hr day <br />I. Routine Report <br />II. Report (includes DUP, MS <br />Signator Signature <br />Signature <br />Printed Name <br />_5 <br />standard (-10-15 working days) <br />Provide verbatffevminary Results <br />MSD, as required, maybe <br />charged as samples) <br />Prin_ til Name Printed Name <br />Printed Name <br />Firm J <br />Provide FAX Preliminary Results <br />RequestedReportDate: <br />III. Data Validation Report <br />(includes All Raw Data) <br />Firm Firm <br />Firm <br />d}Jit>Li <br />DaWrime <br />L Q Z 3 <br />X <br />RWQCB <br />(MDLs/PQLsnRACE#) <br />Date/Time 1, Z-). 0,L Datefrime <br />Date/Time <br />RELINQUISHED BY RECEIVED BY <br />Special Instructions/Comments: <br />Container Types Key: <br />Please report MDLs, PQLs and Trace. <br />Columbia Analytical <br />8030 Remmet Avenue <br />40 ml VOA: <br />250 ml LPE: <br />1 <br />2 <br />Signature Signature <br />Nitrate -Nitrogen <br />has a 48 -hr <br />hold <br />thnei <br />Suite 2 <br />Canoga Park, Ca 91304 <br />500 ml LPE: <br />1 liter HDPE: <br />3 <br />4 <br />Printed Name Printed Name <br />818-316-0904 /Fk 316-0896 <br />Contact: Karen Ryan <br />500 ml glass: <br />I liter glass: <br />5 <br />6 <br />Firm Firm <br />EDDs "usan.waterman <br />@shawgrp.com> <br />Ship UPS Acct 9653131 `' <br />2x6 s/s ring: <br />7 <br />Datelrime DatelTime <br />glass)ar: <br />8 <br />