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CHAIN OF CUSTODY LABORATA.ANALYSIS REQUEST FORM Page <br /> Shaw Environmental P.O.No: Direct Bill San Joaquin County <br /> 180 Promenade Circle Shite 320 Sacramento CA 95834 r Lab: BC Labs Bakersfield <br /> Project Name:Foothill Landfill,San Joaquin County Analysis Requested <br /> 1st Quarter Sampling 2011 <br /> Project Number: 139867(Leachate) o <br /> Report to: Sheila Richgels,Shaw Environmental <br /> <sheila.rlchgels@shawgrp.com> 916-565-4327 �a <br /> CC Report to: Jody Rhoades,Shaw Environmental o v <br /> <jody.rhoades@showgrp.com> 916-565-4362 U 8 -014 <br /> 48U � r/] c l�i oNo <br /> Sampler's Signature: 1 v `1, <br /> rn c3 <br /> REMARKS <br /> Sample 2011 LAB Sample } L LPB 250ml 5001n1 VOA Container Types <br /> I.D. Date Time I.D. Matrix NP NP HNO3 HCl Preservations <br /> L-01 1,26--y 'A water 6 1 1 1 3 CHK <br /> SHORT H I Q TIME <br /> Cr" nUr 00 <br /> DO Cl2 BOD MBAU <br /> RELINQUISHED BY RECEIVED BY RELINQUISHED BY RECEIVED BY TURNAROUND REPORT RE,QUIREMENTS <br /> REQUIREMENTS X I. Routine Report <br /> fPriNZe <br /> Sig, ure Sign a aturJ� 24 hr 4g hr 5 day 11. Report(includes DUP,MS <br /> X Standard(—I0.15 working days) MSD,as required,may be <br /> Pri d Na a Arigg��yd NamQJ� Printed ame Provide Verbal Preliminary Results charged as samples) <br /> Db mL �JLxk� Provide FAX Preliminary Results III.Data Validation Report <br /> Pi �^1e-;+ Firm_ Firm Firm Requested Report Data: X (includes All Raw Data) <br /> C) L114A <br /> Date/Time ✓ G J� Date/Time /194,1 l Date/Time tb i DLs/P Ls/TRACE# <br /> RELINQUISHED BY RECEIVED BY Special Instructions/Comments: Container Types Key: <br /> BC Labs-Tina Green 40 ml VOA: i <br /> natur Signature Please report MDLs,PQLs and Trace. 4100 Atlas Court 250 ml LPE: 2 <br /> Nitrate-Nitrogen has a 48-hr hold time. Bakersfield,Ca 93308 500 ml LPE: 3 <br /> Printed Name ed Name �, 661-327-4911/Fx:327-1918 1 liter HDPE: 4 <br /> !,A Ship via UPS Acct 965376 500 ml glass: 5 <br /> Firm Finn Lab Courier: Ross Dickey I liter glass: 6 <br /> EDDs to<susan.waterman rQr shawgrp.com> 661-201-4171 2x6 s/s ring: 7 <br /> Da • I Q Date/Time lass'ar: 8 <br />