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CHAIN OF CUSTODY/LABORAORY ANALYSIS REQUEST FORM Pagef <br /> — <br /> P.O.No: Direct Bill San Joaquin County <br /> ® Lab: BC Labs,Bakersfield <br /> a 180 Promenade Circle Suite 320 Sacramento CA 95834 <br /> Project Name: Foothill Landfill,San Joaquin County Analysis Re uested <br /> Surface Water Sampling 2012 .. <br /> Project Number: 139867 (Surface Water) <br /> Report to: Sheila Richgels,Shaw Environmental pa <br /> <sheila.richgels@shawgrp.com> 916-565-4327 v <br /> CC Report to: Jody Rhoades,Shaw Environmental o 00 n q <br /> <jody.rhoades@shawgrp.com> 916-565-4362 U < o z , <br /> o <br /> Sampler's Signature: y H d w <br /> VU , o _iil°' c <br /> j REMARKS <br /> Sample 2012 LAB Sample voA Liter LPE 250m) sooml Container Types <br /> I.D. Date Time I.D. Matrix Hcl NP NP �rros Preservations <br /> S-1 water 6 3 1 1 . <br /> S-2 water 6 3 1 1 I <br /> RELINQUISHED BY RECEIVED RELINQUISHED BY RECEIVED BY TURNAROUND REPORT REQUIREMENTS <br /> REQUIREMENTS X I. Routine Report <br /> Signature Sigpfdure Signature Signature 24 hr ®48 hr -5day II. 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 /> ZZ Provide FAX Preliminary Results III.Data Validation Report <br /> Firm Firm Firm Firm Requested Report Date: (includes All Raw Data) <br /> Shaw Environmental X RWQCB <br /> Date/Time Date/Time Date/Time Date/Time (MDLs/PQLs/TRACE#) <br /> RELINQUISHED BY RECEIVED BY Special Instructions/Comments: <br /> BC Labs-Tina Green <br /> Signature Signature Please report MDLs,PQLs and Trace. 4100 Atlas Court <br /> Nitrate-Nitrogen has a 48-hr hold time. Bakersfield,Ca 93308 <br /> Printed Name Printed Name 661-327-4911/Fx:327-1918 <br /> Ship via UPS Acct 965376 <br /> Firm Firm <br /> EDDs to<susan.waterman@shawgrp.com> <br /> Date/Time Date/Time <br />