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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 (Ground Fater) <br /> Report to: Sheila Richgels o <br /> Company: Shaw Environmental i pa <br /> Address: 1326 North Market Boulevard v <br /> Sacramento,CA 95834 0 O° �n <br /> Dir Ph: (916)565-4327 / X: (916)56J-4356 4.o W o <br /> 78 <br /> Sampler's Signature: kztJt.1Jk- <br /> Sample <br /> z > �" z U REMARKS <br /> LAB Sample 1:. VOA . Li2erLPE 250m1 SOOmI 1contamer Types <br /> I.D. Date Time 1.D. Matrix Hcl NP NP HNO3 Preservations <br /> IVIw- <br /> a MW-2R 11414 , water 6 3 1 1 1 <br /> �J MW_, <br /> T MW-4 Z3water 6 3 1 1 1 <br /> NF*-S le <br /> vVitmi —o <br /> LW-1 121 ,j 1 water 6 3 1 1 1 <br /> Field Blank �`t`���1 tJ1A water 2 2 <br /> Trip Blank Ip, water 2 2 3 <br /> RELINQUISHED BY RECEIVED BY RELINQUISHED BY REC IVE B TURNAROUND REPORT REQUIREMENTS <br /> REQUIREMENTS Q X I. Routine Report <br /> Si re Signature Signature afore 00e _ 24 hr _48 hr _5 day U. Report(includes DUP,MS <br /> l� tX <br /> Stands d(-10-15 working days) MSD,as required,may be <br /> Pri Na -/RU <br /> Provide FAX Preliminary Results III.Data Validation.Report <br /> Fire Firm Firm F' ?� t r� r'� _ Requested Repon Date: (includes All Raw Data) <br /> i t% b t3 !� X RWQCB <br /> Date/time J-191i %40 Date/Time Date/Time Date/time (MDLs/PQLs/TRACE#) <br /> RELINQUISHED BY RECEIVED BY Special Instructions/Comments: Container Types Key: <br /> Columbia Analytical 40 ml VOA:' ly <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 /> " <br /> Film Contact: Karen Ryan 500 ml glass: 5 <br /> Firm UPS Acct 9653E1 I liter glass 6 <br /> EDDs to<susan.waterman@shawgrp.com> 2xit s/s ring; 7 <br /> Date/Time Date/Time <br /> glass jar: 8 <br />