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r. <br /> CHAIN OF CUSTODY / LABORATORY ANALYSIS REQUEST FORM Pagf' —of_ <br /> SHAW Environmental & Infrastructure, Inc. PO Number: 189808 for 2002' <br /> 1326 North Market Boulevard,Sacramento,CA 95834 `f, Lab: Sequoia Analytical,Sacto <br /> Project Name: Harney Lane Landfill,San Joaquin County Anal sis Requested <br /> Project Number: 791290/00007000 <br /> Project Manager: Steve Giacomini <br /> Company: SHAW Environmental & Infrastructure,Inc. a 2 <br /> 0 <br /> Address: 1326 North Market Boulevard a <br /> Sacramento,CA 95834 U w <br /> Dir Pit: (916) 565-4335 1 F (91C)56 -4356 w o <br /> o �o 0 <br /> Sampler's Signature: A ? W <br /> z H '� REMARKS <br /> Sample LAB Sample $ I Container Types <br /> Ln. Date Time I.D. Matrix IICI Preservations <br /> MW-1 7•Z L water 3 3 110 1 <br /> RELINQUISHED BY RECEIVED BY RELINQUISHED BY RECEIVED BY TURNAROUND REPORT REQUIREMENTS <br /> REQUIREMENTS X I. Routine Report <br /> Si tutu Si are Signature Signature 14hr 48hr 5day II. Report(includes DUP,MS <br /> X Standard(-10-15 working days) MSD,as required,may be <br /> Print ame PrintedName Printed Name Printed Narri9 Provide Ve"Prdir inary Results charged as samples) <br /> —{ V) Provide PAX PtetninvyResults III.Data Validation Report <br /> Fit Firm Firm Requested Report pate: (includes All Raw Data) <br /> X RWQCB <br /> Date/Time -Z-OZ- Dat -Me 05Q' Date/Time Date/Time (MDIAIPQLvTRACEN) <br /> RELINQUISHED BY RECEIVED BY Special Instruction/Conuesents: n �a Container Types Key: <br /> 1�—1-7 DC Sequoia Analytical 40 ml VOA: I <br /> Signature Signature Please report MDIs,PQLs,and Trace. 819 Striker Avenue,Ste,8 250 ml LPE: 2 <br /> Sacramento,Ca 95834 500 ml LPE: 3 <br /> Printed Name Printed NameV..'" -� a� f n"t-S � 916-921-9600 1 liter HDPE: 4 <br /> Contact: Ron Chew 500 ml glass: 5 <br /> Firm Firm &As-tKks. '., l liter glass: 6 <br /> it 2x6 s/s ring: 7 <br /> Date/Titue jDaterime glass jar: 8 <br />