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CHAIN OF CUSTODY /LABORAORY ANALYSIS REQUEST FORM Page <br /> f— <br /> P.O.No: Direct Bill San Joaquin County <br /> Shaw® 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 2012 <br /> Project Number: 139867 (Lysimeters) <br /> Report to: Sheila Richgels,Shaw Environmental <br /> <sheila.richgels@shawgrp.com> 916-565-4327 110 2 <br /> CC Report to: Jody Rhoades,Shaw Environmental o a <br /> <jody.rhoades@shawgrp.com> 916-565-4362 p� o <br /> o W b <br /> Sampler's Signature: a z [� <br /> O 4 <br /> bj °D1 IRENTARKS <br /> Sample 2012 LAB Sample von L LPs zsotnl soot�t Container Types <br /> I.D. Date Time I.D. Matrix HCI NP taP Hrzos Preservations <br /> LZ-01 water 6 3 1 1 1 <br /> LZ-02 water 6 3 I I '" 1 <br /> LZ-03 water 6 1 3 1 <br /> LZ-04 water 6 3 11 I 1 <br /> RELINQUISHED BY RECEIVED BY RELINQUISHED BY RECEIVED BY TURNAROUND REPORT REQUIREMENTS <br /> REQUIREMENTS X 1. Routine Report <br /> Signature Signature Signature Signature 24 hr _4a hr _5day II. Report(includes DUP,MS <br /> X Standard(--10-15 working days) MSD,as required,may be <br /> Printed Name Printed erne Printed Name Printed Name Provide verbal Preliminary Results charged as samples) <br /> Provide FAX Preliminary Results III.Data Validation Report <br /> Firm Irm Firm Firm Requested Report Date: (includes All Raw Data) <br /> Shaw Environmental X RWQCB <br /> Date/Time Date/Time Date/Time Date/Time (MDLs/P LS/TRACE <br /> RELINQUISHE Y RECEIVED BY Special Instructions/Comments: <br /> BC Labs-Tina Careen <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 /> DatetTime Date/Time <br /> .. - ..- _ ........ <br />