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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 'Sacramento CA 95834 Lab: CAS,Simi Valley <br /> Project Name:Foothill Landfill,San Joaquin County Analysis Re nested <br /> Project Number: 124591 (Ground Water) <br /> Report to: Sheila Richgels o <br /> Company: Shaw Environmental <br /> Address: 1326 North Market Boulevard ` oho ti <br /> Sacramento,CA 95834 <br /> .a <br /> Dir Ph; (916)565-4327 / AX: (916),565-4356 0 f' ' o 4 <br /> a <br /> Sampler's Signature: O o °� °n, <br /> REMARKS <br /> Sample L ample vOA Liter LPE 250m1 5001 6 1 1 C-tai—Types <br /> I.D. Date Time I.D. Matrix EK3 NP NP I EN03 NP Preservations <br /> Mw-5 water . 8 3 1 .1 1 2 <br /> ILip Blank water 2 2 <br /> RELINQUISHED BY RECEIVED BY RELINQUISHED BY R;MYCL tj TURNAROUND REPORT REQUIREMENTS <br /> REQUIREMENTS X I. Routine Report <br /> Si tur SignatureSignature S'gnatttre -hr _4s hr 5 day H. Report(includes DUP,MS <br /> f-tX smnaard(-tats worm s�YB) MSD,as required,may be <br /> N Printed Name Printed Name Printed Name Provide verba]Prellmtoary itesmts charged as samples) <br /> CA� Provf&FAXPt1ftn1uryRwu1ts III.Data Validation Report <br /> Ft jet Firm F;rm Requested Report Date: (includes All Raw Data) <br /> to. l X RWQCB <br /> Datefrime `k\-05 I Date/time DateMrne Daternme (MDLs/PQLs/TRACE#) <br /> RELINQUISHED BY RECEIVED BY Special Instructions/Comments: Container Types Key <br /> Columbia Analytical 40 ml VOA: I <br /> Signature Signature Please report MDLs,PQLs and Traco. 2655 Park Center Drive,Suite A 250 nil LPE: 2 <br /> Nitrate-Nitrogen bas a 48-hr hold time. Simi Valley,CA 93065 500 m1 LPE: 3 <br /> Printed Name Printed Name 805-526-7161/Pk 805-526-7270 1 liter HDPE: 4 <br /> Firm Firm Contact: Karen Ryan 500 ml glass: 5 <br /> UPS Acct 9653E1 l liter glass: 6 <br /> EDDs to<snsan.waterman@shawgrp.com> iter <br /> sJs ring: 7 <br /> Datelfime Date/Time <br /> glass jar. 8 <br />