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M M M ® M M M M M M M <br />CHAIN OF CUSTODY / LABORATORY ANALYSIS REQUEST FORM Page — of <br />Shaw Environmental 7411--• P.O. No: Direct Bill San Joaquin County <br />1326 Nnrth Market Rm4Pvnrrl Carrnmc+ntn CA 9GRAA �--� d d . j T -1-. 11A o -- zr_■.___ <br />Project Name: Foothill Landfill, San Joaquin County <br />Analysis <br />Requested <br />Project Number: 124591 (Ground Water) <br />Report to: Sheila Richgels <br />Company: Shaw Environmental <br />G o <br />w <br />Address: 1326 North Market Boulevard <br />°CIO <br />� <br />v <br />Sacramento, CA 95834 <br />� j Q <br />Z <br />Dir Ph: (916) 565-4327 / F (916) 565-43560 <br />W <br />o <br />° <br />'o <br />R <br />PQ <br />w <br />t+l t��./ 1. �.fi . ttf-' ,y;� <br />Sampler's Signature: t'�' <br />U <br />� <br />Z <br />E <br />U <br />z <br />_" <br />REMARKS <br />Sample <br />LAB Sample <br />VOA <br />". <br />rater <br />250n,1 <br />soonli <br />Container Types <br />I.D. Date <br />Time <br />I.D. Matrix <br />aci <br />ivy <br />rrp <br />11NO3 <br />Preservations <br />MW -1 10-4 <br />-A V <br />water <br />6 3 <br />1 <br />1 <br />1 <br />MW -2R <br />water <br />6 3 <br />1 <br />1 <br />1 <br />MW -3 ai`I3 <br />water <br />6 3 <br />1 <br />1 <br />1 <br />LW -1 9�4, <br />iY?' <br />water <br />6 3 <br />1 <br />1 <br />1 <br />ield Blank <br />ems. <br />J..� water <br />2 2 <br />''r!Blank <br />t,11A <br />water <br />2 2 <br />'l <br />RELINQUISHED BY <br />RECEIVED BY , <br />RELINQUISHED BY <br />REC <br />TURNAROUND REPORT REQUIREMENTS <br />qignature <br />REQUIREMENTS X <br />21 hr 48 br 5 day <br />L Routine Report <br />11. Report (includes DUP, MS <br />Sig e t11 <br />Signature <br />Signature <br />Printed Name (/ ppmS <br />CAS <br />J41 X <br />standard (-10-15 waking days) <br />Provide Verbal Preliminary Results <br />MSD, as required, maybe <br />charged as samples) <br />Print _ ame 99 <br />Printed Name <br />Printed Name. <br />�i0 <br />F <br />1 <br />Provide FAX Preliminary Results <br />RegnestedReport Date: <br />111. Data Validation Report <br />(includes All Raw Data) <br />Firm <br />A <br />Firm <br />Firm <br />]Date Mine <br />0 <br />X <br />RWQCB <br />(MDLs/PQLvrRACE#) <br />Date/Time - y`y ) ;ems <br />Daterrime <br />Date/Time <br />RELINQUISHED BY <br />RECEIVED BY <br />Special Instructions/Comments: <br />Container Types Key: <br />Please report MDLs, PQLs and Trace. <br />Columbia Analytical <br />2655 Park Center Drive, Suite A <br />40 nd VOA: <br />250 nil LPE: <br />1 <br />2 <br />Signature <br />Signature <br />Nitrate -Nitrogen has a 48 -hr <br />hold <br />time. <br />Simi Valley, CA 93065 <br />805-526-7161/ Fx 805-526-7270 <br />500 ml LPE: <br />1 liter HDPE: <br />3 <br />4 <br />Printed Name <br />Printed Name <br />Contact: Karen Ryan <br />UPS Acct 9653E1 <br />500 ml glass: <br />1 liter glass: <br />5 <br />6 <br />Firm <br />Firm <br />EDDs to <susan.waterman@shawgrp.com> <br />2x6 s/s ring: <br />glass jar: <br />7 <br />8 <br />DatelTime <br />DatelTime <br />