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CHAIN OF CUSTODY LABORATORY ANALYSIS REQUEST FORM Page_of_ <br /> Shaw Environmental <br /> P.O.No: Direct Bill San Joaquin County <br /> 1326 North MarketToulevard Sacramento CA 95834 -- - 9 7 Lab: CAS,Simi Valle <br /> Project Name:Foothill Landfill,San Joaquin County Analysis Requested <br /> Project Number: 124591 (Resample) <br /> Report to: Sheila Richgels . <br /> <sheila.richgels@shawgrp.coin> <br /> 00 <br /> Company: Shaw Environmenta a a <br /> Dir Ph: (916)565-4327 / FA ( 6)56 -4356 0 <br /> 4. 0 <br /> Sampler's Signature: c <br /> REMARKS <br /> Sample LAB Sample VOA ContamerTypes <br /> I.D. Date Time I.D. Matrix HCI Preservations <br /> MW-3. �3 water 3 3 <br /> Trip Blank water 2 2 <br /> RELINQUISHED BY RECEIVED BY RELINQUISHED BY// TURNAROUND REPORT REQUIREMENTS <br /> REQUIREMENTS X I. Routine Report <br /> Siur Signature Signature ature 24 hr _48 hr 5 day I1. Report(includes DUP,MS <br /> X Standwd(-.10-15 working days) MSD,as required,may be <br /> Pri#t4d Name Printed Name Printed Name Printed Name^ Provide Verbal Preliminary Results charged as samples) <br /> L � V— Provide FAX Preliminary Results III.Data Validation Report <br /> Finn /+ Firm Firm F' Requested Report Date: (includes All Raw Data) <br /> J X RWQCB <br /> DatetTime Daterrime Datefrime Date/r'ime (MDLs/PQLs/IRACE#) <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 /> 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 /> Flim Firm UPS Acct 9653EI l liter glass: 6 <br /> EDDs to<susan.waterman@shawgrp.com> 2x6 s/s ring: 7 <br /> Date/I ime Datelrime glass jar 8 <br />