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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 Re uested <br /> Project Number: 124591 (Lysimeters) <br /> Report to: Sheila Richgels o <br /> Company: Shaw Environmental o <br /> Address: 1326 North Market Boulevard N <br /> Sacramento,CA 95834 0 °O G <br /> Dir Ph: (916)565-4327 1 FAX: (916)5654356 0 boU <br /> Sampler's Signature: O A o �+ <br /> 0 <br /> E~ ¢ z U ?0S REMARKS <br /> Sample LAB Sample VOA L LPEmi 500m1 Container Types <br /> I.D. Date Time I.D. Matrix HCl NP NP HNO3 Preservations <br /> LZ-01 water 6 3 1 1 1 <br /> LZ-02 water 6 3 1 1 1 <br /> LZ-03 water 6 3 1 1 1 <br /> LZ-04 water 1 1 1 <br /> RELINQUISHED BY RECEI BY RELINQUISHED BY RECEIVED BY TURNAROUND REPORT REQUIREMENTS <br /> REQUIREMENTS X I. Routine Report <br /> Signature gnature Signature Signature 24 hr 48 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 /> Finn Finn Finn Film Requested Report nate: (includes All Raw Data) <br /> X RWQCB <br /> Date/Time DateCfime Date/Time Date/Time (MDLs/PQLs/TRACE#) <br /> RELINQUISHED BY RECEIVED BY Special Instructions/Comments: Container Types Key: <br /> Columbia Analytical 40 ml VOA: i <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 /> Finn Firm UPS Acct 9653E1 1 liter glass: 6 <br /> EDDs to<susan.waterman®shawgrp.com> 2x6 s/s ring: 7 <br /> Date/Time DatePCime <br /> glass jar. 8 <br />