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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 Vall <br /> Project Name:Foothill Landfill,San Joaquin County Analysis Re uested <br /> Project Nurnber: 124591 (Ground Water) <br /> Report to: Sheila Riehgels d <br /> Compact}': Shaw Environmental <br /> Address: 1326 North Market Boulevard a <br /> Sacramento,CA 95834 0 00 <br /> Dir Ph: (916)5654327 / F 356 <br /> (916)56 <br /> ,�' o <br /> Sampler's Signature: LI �, •p ;; ,� <br /> O rte ° a <br /> Sam le , U �% REMARKS <br /> p .LAB Sa1np a VOA Liter LPE 25009 500at1 Container Types <br /> I.D. Date Time LD. Matrix KCl NP NP HNO3 Preservations <br /> 1 <br /> MW-3 %..15. �o % water G 3 1 1 1 <br /> �✓ 1 <br /> MW-5 4 rS'cr� water G 3 1 1 1 <br /> WHOR <br /> Tri2 Blank �`►�•� ial water. 2 2 <br /> RELINQUISHED BY RECEIVED BY RELINQUISHED BY i RE :EI EllSTURNAROUND REPORT REQUIREMENTS <br /> _44REQUIREMENTS X L Routine Report <br /> Si Signature Signature 3rgnature t 241u 4a 1x _5 day II. Report(includes DUP,MS <br /> P <br /> X SW.Wd(•IU-15 workmS daga) MSD,as required,may <br /> ` be <br /> ' Naut Printed Name Printed Name PrintProvide V�ba1 Preawry R:snus <br /> Printed Name S lm charged as samples) <br /> AS Provide FAX Prelim Rtmdu III.Data Validation Report <br /> F �"•yT� <br /> Firm Firm Firm Requited R-Port Dattz (includes All Raw Data) <br /> X RWQCB <br /> Dated ime — ty rh Data/irft Datelrime IlAueliffne — (MDIs/PQI s/TRACE ) <br /> RELINQUISH BY RECEIVED BY Special Insh—tions/Comments: Container T E <br /> }P e)•: <br /> Columbia Anah)tical 40 ml VOA: <br /> Signature Signature Pleose report 11rDLs,PQLs and Truce. 2655 Park Center Drive,Suite A 250 mi LPE: <br /> Nitrate-Nitrogen has a 48-hr hold time. Simi Valley,CA- 93065 500 ml LPE: <br /> Printed Name Primed Name 805-526-7161/F-c 805.526-7270 1 liter HDPE: <br /> firm Firm <br /> Contact: Kam Ryan 500 ml glass: <br /> UPS Aoct 96S3EI 1 liter <br /> glass: <br /> EI)Ds to*snsanwoterman�E.shaw•grp.com> 2sG s!s ring; <br /> Datell'imn Date/time <br /> glass jar: <br />