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! 9 0 1/1 <br />CHAIN OF CUSTODY / LABORATORY ANALYSIS REQUEST FORM Page _of _ <br />Shaw Environmental P.O. No: San Joaquin County P.O.#21356 <br />1211. RC Labs. Bakersfield <br />North Market Boulevard, Sacramento, CA 95834 <br />\v ► <br />—'- <br />1326 <br />Project Name: Foothill Landfill, San Joaquin County <br />Analysis <br />R nested <br />5 -Year COC Event / Ground Water <br />:2 <br />Project Number: 124591 <br />Report to: Sheila Richgels (916-565-4327) <br /><sheila.richgels@shawgrp.com>o <br />cc Report to: Jody Rhoades (916-565-4362) <br /><jody.rhoades@shawgrp.com) 0 <br />Sampler's Signature: z <br />Sample LAB ample <br />1.D. Date Time I,D. Matrix <br />S <br />0 w <br />U <br />�' U <br />Liter LPE <br />y <br />o <br />0N0 <br />O <br />500 GIs VOAs <br />w <br />U Q <br />U <br />0N0 0o <br />LGIs <br />tz o <br />m t1a <br />500m1 <br />o <br />In <br />Z <br />'c1 U <br />SOUmt SObml <br />REMARKS <br />Container Types <br />Preservations <br />NP <br />d HCl <br />NP <br />HNO3 <br />NuOH <br />1 <br />1 1 <br />MW -2R —1"1 "� water <br />1 <br />1 3 <br />MW -4 wafer <br />MW -5 _ °�`� water i 1 <br />t <br />1 3 <br />4- <br />1 <br />l 1 <br />LW -1 --1"? i�w�a <br />water 1 t 1 3dw <br />Field Blank 11ph <br />water <br />RE, BY RECEIVED BY <br />E <br />RELINQUISHED BY RECEIVED BY <br />TURNAROUND <br />REQUIREMENTS <br />REPORT REQUIREMENTS <br />X I. Routine Report <br />Si are Si lure <br />Si �n are Signature <br />24 t¢ �48 hr 5 day <br />stmtdard (-10-15 work; ag days) <br />II. Report (includes DUP, MS <br />MSD, as required, may be <br />P t dNume, P ' d Name <br />` � �f C <br />p{rm <br />. 9 p X43 <br />Jute/Time,1 <br />Date/Time f�L) Dale/Time �} Q <br />RELINQUISHED BY RE,CE 'VED BY <br />Signature Signature <br />gy ,g 53 <br />Prime Name Printed Name <br />2204�0 <br />Firm Firm rf <br />"7 r/ 's co <br />P ' ted N e t Printed Name <br />S Q `,ay L ��, <br />Fi Pima <br />�.. <br />9 j <br />Dute/Timed (�� Date/Tim <br />Special Instructions/Comments: <br />REFER TO Table VI ATTACHED for 5 -YR Purr meters. <br />Please report MDLs, PQLs unit Trace. <br />Nitrate -Nitrogen has a 48 -hr hold time. <br />Metals: Ca, Mg, K, Na, Al, Sb, Ba, Be, Cd, Cr, Co, <br />Cu, Ag, Sty V, Zn, Fe, Mty As, Pb, Hg, Ni, Se, ,ri <br />Provide Verbal Prel¢tdtrary Results charged as rumples) <br />Provide fAX Prelindriary Resulta I1L Data Validation Report <br />Requested Repon Data; (includes All Raw Data) <br />X ItWQCB <br />(MDLs/PQLs/TRACEtt) <br />Contu40 ml pas Key: <br />BC Labs - Tina Green 4(1 tnVOA: <br />4100 Atlas Court 250 ml LPE: <br />Bakersfield, Ca 93308 500 ml LPE: <br />661-327-4911 / Fx: 327-1918 1 liter HDPE: <br />Ship via UPS Acct 965376 500 nil glass: <br />Field Support: Peter Bins 1 liter glass: <br />(408) 391-2942 2x6 s/s r-. <br />g1:15S)al" <br />l <br />2 <br />3 <br />4 <br />5 <br />6 <br />7 <br />K <br />Date/Time Date/Time <br />