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CHAIN OF CUSTODY LABORATORY ANALYSIS REQUEST FORM Page_of_ <br /> Shaw Environmental P.O.No: Direct Bill San Joaquin County <br /> 180 Promenade Circle Suite 320 Sacramento CA 95834 Lab: BC Labs,Bakersfield <br /> Project Name:Foothill Landfill,San Joaquin County Analysis Re uested <br /> 1st Quarter Sampling 2011 <br /> Project Number: 139867 (Surface Water) o <br /> Report to: Sheila Richgels,Shaw Environmental V pa <br /> <sheila.richgels@shawgrp.com> 916-565-4327 $ V <br /> CC Report to: Jody Rhoades,Shaw Environmental o °� m <br /> <jody.rhoades@shawgrp.com> 916-565-4362 U ��, z w <br /> 4. <br /> Sampler's Signature: !u a H <br /> CCn� O <br /> F i REMARKS <br /> Sample LAB Sample von Liter LPE 250tnl so Container Types <br /> I.D. Date Time I.D. Matrix HCl NP NP HNO3 Preservations <br /> S-1 water 6 3 1 1 <br /> S-2 water 6 3 1 1 <br /> RELINQUISHED BY RECEIVED BY RELINQUISHED BY RECEIVED BY TURNAROUND REPORT REQUIREMENTS <br /> REQUIREMENTS X I. Routine Report <br /> Signature Signature Signature Signature 24 hr 49 hr _5 day U. Report(includes DUP,MS <br /> X Standard(-10-15 working days) MSD,as required,may be <br /> Printed Name Printed Name Printed Name Printed Name Provide Verbal Preliminary Results charged as samples) <br /> Provide FAX Preliminary Results III.Data Validation Report <br /> Firm Firm Firm Firm Requested Report nate: (includes All Raw Data) <br /> X RWQCB <br /> Date/Time Date/Time Date/Time Date/Time MDLs/PQLsMZACE#) <br /> RELINQUISHED BY RECEIVED BY Special Instructions/Comments: Container Types Key: <br /> BC Labs-Tina Green 40 ml VOA: 1 <br /> Signature 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 Printed Name 661-327-4911/Fx:327-1918 1 liter HDPE: 4 <br /> Ship via UPS Acct 965376 500 mi glass: 5 <br /> Firm Firm Lab Courier: Ross Dickey 1 liter glass: 6 <br /> EDDs to<susan.waterman a shawgrp.com> 661-201-4171 2x6 s/s ring: 7 <br /> Date/Time Date/Time glassjar: 8 <br />