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CHAIN OF CUSTODY/ LABORATORY ANALYSIS REQUEST FORM Page_of <br /> Shaw Environmental j 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 Requested <br /> Project Number: 124591(Leachate Module) <br /> Report to: Sheila Richgels <br /> Company: Shaw Environmental q <br /> Address: 1326,North Market Boulevard <br /> Sacramento,CA 95834 [ <br /> Dir Ph: (916)565-4327 Fax (91b)565-4 56 �. n o � w"' U o <br /> 00z <br /> Samplers Signature: y q N z �, v <br /> A ° °p q <br /> H v z U > w REMARKS <br /> Sample LAB Sample -,-'L LPE 2501n1 500m1 VOA Container Types <br /> I.D. Date Time I.D. Matrix NP NP HNO3 HCl Preservations <br /> L-01 }-1S water 6 1 1 1 3 <br /> RELINQUISHED BY RECEIVED BY�/ RELINQUISHED BY RECJuJVE B. TURNAROUND REPORT REQUIREMENTS <br /> v REQUIREMENTS X I. Routine Report <br /> Si Signature Signature S' afore 24 hr 48 hr _5 day II. Report(includes DUP,MS <br /> I ► _ X Standard(-10.15 working days) MSD,as required,may be <br /> PrinfqA Name �. Printed Name Printed Name Printed Namel., A� Provide Verbal Preuntinaty Results charged as samples) <br /> p� ""''" ' 1. A Provide FAX Preliminary Results III.Data Validation Report <br /> Firm .� Firm Firm Fi _ #� Requested Report Date: (includes All Raw Data) <br /> �V X RWQCB <br /> Date/Time 1-11`0 )W10 Date rime Date/Time Date/Time (MDLs/PQLs/TRACE#;) <br /> RELINQUISHED BY RECEIVED BY Special Instructions/Comments: Container Types Key: <br /> Columbia Analytical 40 ml VOA: 1 <br /> Signature Signature Please report MDLs,PQLs and Trace. 2655 Park Center Drive,Suite A 250 nil LPE: 2 <br /> Nitrate-Nitrogen has a 48-hr hold time. Simi Valley,CA 93065 500 nil LPE: 3 <br /> Printed Name Printed Name 805-526-7161/Fx 805-526-7270 1 liter HDPE: 4 <br /> Contact: Karen Ryan 500 mi glass: 5 <br /> Firm Firm UPS Acct 9653EI I liter glass: 6 <br /> EDDs to<susan.waterman@shawgrp.com> 2x6 s/s ring: 7 <br /> Daterrime Date/Time glass jar: 8 <br />