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Excelchem Environmental Labs <br /> RWQC Central Valley Project: 931 Oro <br /> 11020 Sun Center Dc#200 Project Number: 12-095-150 Date Reported: <br /> Rancho Cordova,CA 95670 Project Manager: Jim Barton 09/10/13 11:31 <br /> Laboratory Analyses.Request Form <br /> PCA Na 12-a6.150 <br /> StWTPe n: Jina_Dprwo Iteidl Dauer Approved by: _Cori Comim, <br /> 5 nwr{SUPr rta S6nO1 <br /> Sample Location•;N lLnt.of Visebarger): 931 S.Oro SU.Stockton-Sun Joaquin Co. <br /> Datc and'I it0c of DCPartun lrona 0111ce. 8/26/2013 0800'hours <br /> Date trod'Lime of SampLing! 8/26/2013. 1000 bouts <br /> Date and Time of Delivery to Laborwtory- 8/26720/3 1400 botsm <br /> purpose of Sampling: Drinking%Vater ComlilainLto State Water Rea>urces Clontml Board', <br /> sample,Rites(Attach map if nvailable): Tank insid'c timL,cc antl outside hose bib <br /> Hovcbofllcs mtd CQCs.. Will drop r_.aTsanrplus at lab_ SLd.ram-around IMO. <br /> Atra(yscs Requested /1'oi' C_'onlracUPO# Bid Group Uriit Cusil Net Cost <br /> mttles <br /> DW Volatile Or amc Com full scan 12-099-150 CIM One 811'0.00 qf20�00 <br /> Tei"rive rdemircd c,om ,,ands above 2 12-(!95_150 O Orm $1.0:00 Semivolnlilc Petroleum H drocrbons <br /> 2 L2-095-150 'Three $25.U0 Pur esble Pctrolcum iI rnerbpns 2 L2-095-150 G Thsec $25.00 Extmctahle Oil &Ci2 12-095-150 CIThree '825.00 Fxtractablo Pornlawn Hvdocvrbotts 2 12-095-150 Gr .Three $25.00 <br /> lbtal i440,0U <br /> Required Dotllem: <br /> 12 vials 6 liter amber gFaas gal..ambor glass <br /> Litor prbaLic CHNO3) liter plastic{H2SGil liter plastic <br /> 250 rnl P16mtic YH SO.L) 'other <br /> MCP form ncocicd7(Include fprsotdor.if needed) <br /> EXcelchem Environmental Lab. The results in this report apply to the samples analyzed in accordance with the chain of <br /> custody document.Thts analytical report most be reproduced in its entirely. <br /> Laboratory Representative <br /> Page 2 of 5 <br />