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CHAIN OF CUSTODY/LABORASkY ANALYSIS REQUEST FORM Page�— <br /> P.O.No: Direct Bill San Joaquin County <br /> shlaW 180 Promenade Circle Suite 320 Sacramento CA 95834 Lab: BC Labs Bakersfield <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 v pq t. <br /> <sheila.richgels@shawgrp.com> 916-565-4327 v ° <br /> CC Report to: Jody Rhoades,Shaw Environmental o 00 n <br /> <jody.rhoades@shawgrp.com> 916-565-4362 w oZ yam:, <br /> o �. b V' bp v <br /> Sampler's Signature: a to [� w <br /> 9 U 110P <br /> o b <br /> j REMARKS <br /> Sample 2012 LAB Sample VOA Liter LPE 2501 5001nl Container Types <br /> I.D. Date Time I.D. Matrix HCl NP ttrro3 Preservations <br /> S-1 water 6 3 1 1 <br /> S-2 water 6 3 1 1 <br /> or <br /> RELINQUISHED BY RE ED BY RELINQUISHED BY RECEIVED BY TURNAROUND REPORT REQUIREMENTS <br /> REQUIREMENTS X I. Routine Report <br /> Signature Signature Signature Signature 24 hr x_48 hr 5 day Il. 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 PAX Preliminary Results III.Data Validation Report <br /> Firm Firm Firm Firm Requested Report nate: (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 Courier: Ross 661-201-4171 <br /> EDDs to<susan.waterman@shawgrp.com> <br /> Date/Time Date/Time <br />