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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 Requested <br /> Project Number: 124591(Surface Water) <br /> Report to: Sheila Richgels o <br /> Company: Shaw Environmental CA <br /> Address: 1326 North Market Boulevard N 2 <br /> Sacramento,CA 95834 U d <br /> Dir Ph: (916)5654327 / FAX: (916)565-4356 0 �0 o z �+ <br /> ai p z -+ <br /> Sampler's Signature: 0 q � o +: <br /> F o <br /> F z � �. REMARKS <br /> Sample LAB Sample VOA Liter LPE oml 500m1 1 lContainer Types <br /> I.D. Date Time I.D. Matrix HCl NP NP llNros Preservations <br /> S-1 water 6 3 1 1 1 <br /> S-2 water 6 3 1 1 1 <br /> Vy <br /> /Y <br /> RELINQUISHED BY RECEIVED RELINQUISHED BY RECEIVED BY TURNAROUND REPORT REQUIREMENTS <br /> REQUIREMENTS X I. Routine Report <br /> Signature Si a Signature Signature i4 hr _4a hr _5 day II. Report(includes DUP,MS <br /> X Standard(--10-15 working days) MSD,as required,may be <br /> Printed Name Printed Name Printed Name Printed Name Provide Verbal Preliminary Results charged as samples) <br /> Provide FAX Preliminary Results III.Data Validation Report <br /> Firm Firm Firm Firm Requested Report Dare: (includes All Raw Data) <br /> X RWQCB <br /> Daterrime DatetTime Date/Time Date Time <br /> (MDLs1PQLs1TRACE#) <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 ml LPE: 2 <br /> Nitrate-Nitrogen has a 48-hr hold time. 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 /> Contact: Karen Ryan 500 ml glass: 5 <br /> Firm Firm UPS Acct 9653E1 1 liter glass: 6 <br /> EDDs to<susan.waterman@shawgrp.com> 2x6 s/s ring: 7 <br /> Date/Time DatetTime glass jar. 8 <br />