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Shaw Environmental CHAIN OF CUSTODY / LABORATORY ANALYSIS REQUEST FORM Page—of_ <br /> -- <br /> - <br /> .1326 North Market Boulevard,Sacramento P.O.No: Direct Bill San Joaquin County CA 95834 Lab: CAS,Simi Valle <br /> Project Name: Foothill Landfill,San Joaquin County --Analysis Requested <br /> Project Number: 124591 (Ground Water) <br /> Report to: Sheila Richgels <br /> Company-: Shaw Environmental Q <br /> Address: 1326 North Market Boulevard <br /> Sacramento,CA 95834 00 <br /> Dir Ph: (y16)365-;327 / F (916)56 4356 w a �� 4-. <br /> Z <br /> Sampler's Signature: <br /> � z <br /> U � <br /> � <br /> Sample �1 O v REMARKS <br /> I-AB Sample VOA Liter LPE 250ml 500m1 Container <br /> I.D. Date Time I.D. Matrix Types <br /> �31 &r .r FtCI NP NP HNO3 <br /> _ <br /> Preservations <br /> r <br /> MW-3 t,i5 d] t,910 / water 6 3 <br /> ,D 1 <br /> MW-5 water 6 3 1 I 1 <br /> wa er <br /> TriBlank %-YS,Cq 01a water 2 2 <br /> RELINQUISHED BY RECEIVED BY RELINQLIISHED BY t "- 2 <br /> TIIRNAROUNll REPORTREQUIREMENTS <br /> Si a Sinature 00, Si storeREQCIREIVIENTS X I. RutttineReport <br /> ignature t 141u 48k 5 dm' Il. Report(includes DUP,MS <br /> .Waal 1 -X sfnndArd(--1x15 working ditvd) MSD,a8 required,ma}'be <br /> Printed Name Printed Name <br /> Printed Name ge samples) <br /> C Provide V.ybx!Prainilnwy Resalts charged its <br /> F• Prewde FAX PrJimmncy RwIilr3 IR.Data Validation Report <br /> Finn Finn Firm' <br /> ,�� I R:2,L�r_d R=port Dal:: (includes x111 Raw Data) <br /> Date//Time 10 X RWQCB <br /> t( Date/Time Datefrime DateiTime <br /> RELINQUISHED BY RECEIVEll BY (MDLs/PQUaRACE#) <br /> Special Instructions/Comments: Container Types Ise} <br /> Columbia Analytical 0 ml VOA: <br /> Signature Signature Please report MDLs PQLs and Trace. <br /> 2655 Park Center Drive,Suite A 250 ml LPE: <br /> Nitrate-Nitrogen has a 48-hr hold thee. Soni Valle}',C.4 93065 500 ml LPE: <br /> Printed Name Printed Name <br /> 805-526-7161,Fs 805-526-7270 t liter HDPE: <br /> Firm Finn <br /> Contact: Karen Ryan 500 ml glass: <br /> UPS Acct 9653EI 1 liter g"-,: <br /> EI)lls to<susanwutennan(d,shangt•p.com> 2.\6 s/s ring: <br /> Date.'Time Date%Time <br /> P>lamjar: <br />