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CHAIN OF CUSTODY /LABORATORY ANALYSIS REQUEST FORM Page_of <br /> P.O.No: Direct Bill San Joaquin County <br /> ShQaw® 180 Promenade Circle Suite 320 Sacramento CA 95834 Lab: BC Labs Bakersfield <br /> Project Name: Foothill Landfill,San Joaquin County Analysis Re uested <br /> 3rd Quarter Sampling 2012 <br /> Project Number: 139867 (Lysimeters) <br /> Report to: Sheila Richgels,Shaw Environmental a Ga c <br /> <sheila.richgels@shawgrp.com> 916-565-4327 �0 2 oo 0 <br /> CC Report to: Jody Rhoades,Shaw Environmental o � ,gyp B <br /> <Jody.rhoades@shawgrp.com> 916-565-4362 <br /> w � <br /> Sampler's Signature: PTA <br /> t*>' z <br /> z <br /> O m REMARKS <br /> Sample 2012 LAB Sample VOA LLPE 250ml 500ml Container Types <br /> I.D. Date Time I.D. Matrix HCl NP NP HNO3 Preservations <br /> LZ-0I water 6 3 1 1 1 <br /> LZ-02 water 6 3 1 1 <br /> LZ-03 water 6 311 1 <br /> LZ-04 water 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 X48 hr 5 day 11. 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 Date: (includes All Raw Data) <br /> Shaw Environmental X RWQCB <br /> Date/Time Datefrime Date/Time Date/Time MDLs/PQLs/TPACE#) <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 Courier: Ross 661-201-4171 <br /> EDDs to<susan.waterman®shawgrp.com> <br /> Date/Time jDatefrime <br />