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Shaw Environmental CHAIN OF CUSTODY/LABORATORY ANALYSIS REQUEST FORM Page_of <br /> � <br /> 1326 North Market Boulevard,Sacramento,CA 95834 P.O.No` Direct Bill San Joaquin County <br /> _ 47 <br /> Lab: CAS,Simi Valley <br /> Project Name: Foothill Landfill,San Joaquin County Analysis Requested <br /> Project Number: 124591 (Resample) <br /> Report to: Sheila Richgels <br /> <sheila.richgels@shawgrp.com> a o <br /> Company: Shaw Environmental a N <br /> 00 <br /> Dir Ph: (916)565-4327 / F 916) 5-4356 0 -.�[ > <br /> U o >, <br /> Sampler's Signature: �� ° o <br /> � A <br /> � _ U <br /> Sample LAB Sample VOA REMARKSContainer Types <br /> I.D. Date Time I.D. Matrix HCI Preservations <br /> MW-2R IV a& water 3 3 <br /> Trip Blank water 2 2 <br /> RELINQUISHED BY RECEIVED BY RELINQUISHED BY RECEIVED BY TURNAROUND REPORT REQUIREMENTS <br /> SiREQUIREMENTS X I. Routine Report <br /> Sign�ah}r Signature S' nature 241v __48 hr _5 day 11. Report(includes DUP,MS <br /> standard(-1015 working days) MSD,as required,may be <br /> Pri �L Nam Printed Name Printed Name ted Provide verbal Preliminary Results charged as samples) <br /> Firma Provide FAX Preliminary Results III.Data Validation Report <br /> SA Fi fitTn i Requested Report Date: (includes All Raw Data) <br /> XRW CB <br /> Date/Time o Date/Time Datelfime DatefIim� (MDLs/PQLs/TRACE#) <br /> RELINQUISHED BY RECEIVED BY Special Instructions/Comments: Container Types Key: <br /> natuColumbia Analytical 40 mi VOA: I <br /> Signature SiPlease report MDLs,PQLs and Trace. 2655 Park Center Drive,Suite A 250 ml LPE: 2 <br /> Simi Valley,CA 93065 500 ml LPE: 3 <br /> Printed Name Printed Name 805-526-7161/Fx 805-526-7270 1 liter HDPE: 4 <br /> FilmFlrm Contact: Karen Ryan 500 ml glass: 5 <br /> ter glass: b <br /> UPS Acct 9653E1 1 li <br /> EDDs to<susan.waterman@shawgrp.com> 2xs/s ring: 7 <br /> Date/time Date/Time <br /> glass jar: 8 <br />