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an m m m ter w m m r MM M m m w <br />a <br />-- <br />LD. <br />— — <br />Date Time LD. Matrix <br />CHAIN OF CUSTODY / LABORATORY ANALYSIS REQUEST FORM Page of <br />HNO3 HCl <br />_ <br />Shaw Environmental, a CBI Company P.O. No: Direct Bill San Joaquin County <br />dh <br />0 <br />180 Promenade Circle Suite 320 Sacramento, CA 95834 Lab: BC Labs, Bakersfield <br />n <br />C <br />Project Name: Foothill Landfill, San Joaquin County <br />Analysis <br />Requested <br />37 <br />c <br />1st Quarter Sampling 2014 <br />1 3 <br />Project Number: 139867 (Leachate) <br />Report to: Sheila Richgels <br />a) <br /><sheila.richgels®CBI.com> 916-565-4327 <br />° � -o <br />a <br />' <br />(4. <br />o <br />It -0(5-7v <br />Jkl <br />w <br />Samplers Signature: <br />o z <br />z N>. <br />-- <br />LD. <br />— — <br />Date Time LD. Matrix <br />NP NP <br />HNO3 HCl <br />�ontamer Types <br />Preservations <br />'17 <br />L-Ol <br />37 <br />water <br />6 1 1 <br />1 3 <br />O <br />3 <br />ILA +a <br />4 <br />M <br />W <br />to <br />CHK BY <br />tH <br />O <br />M <br />N <br />1 UISHED BY <br />RECEIVED BY <br />RELINQUISHED BY <br />RECEIVED BY <br />TURNAROUND <br />Sign e <br />REQUIREMENTS X <br />24 hr day <br />L Routine Report <br />li. Report (includes DUP, MS <br />re <br />Sim <br />Sign rc <br />-d� <br />Pr' ed Name <br />.481v _s <br />XSUMard (d0.1s wor ' <br />w.gaay,) <br />P.Ade varha PreaadP,y ttautu <br />MSD, as required, may be <br />charged as samples) <br />ed Name <br />Prin d Nam <br />Prinf� Name <br />Weinhardt <br />0 SS a2 <br />9 d i <br />Firm //�� <br />Prov da PAX P cartdaa y Re,Wu <br />reay.ea.d xapen uat« <br />III. Data Validation Report <br />(includes All Raw Data) <br />Firm y� <br />Pian / <br />/aLN7a <br />✓v C <br />Datefrime — <br />X <br />RWQCB <br />(MDLsfPQLs/TRACEfI) <br />ITime , , <br />Datefrime , /3,,d <br />Date/Iime i1W& <br />RELINQUISHED BY <br />RECEIVED BY <br />Special rnstructions/Comments: <br />Container Types Key: <br />Please report MDLs. PQLs and Trace. <br />BC Labs -Tina Green <br />4100 Atlas Court <br />40 ml VOA: <br />250 ml LPE: <br />1 <br />2 <br />Signature <br />G <br />Nitrate -Nitrogen has a 48 -hr hold time. <br />Bakersfield. Ca 93308 <br />661327-4911/Fx:327-1918 <br />500 mi LPE: <br />1liter HDPE: <br />3 <br />4 <br />ed Name 1 <br />Printed Name <br />Ship via UPS Acct 965376 <br />Courier: Ross 661-201-4171 <br />500 ml glass: <br />1 liter glass: <br />5 <br />6 <br />(( ^^ <br />Q <br />Firm <br />�! Y <br />13 Ckly,3 <br />2x6 s/s ring: <br />glass jar. <br />7 <br />8 <br />(Time ' 30 <br />Datefrimc <br />�— �, 1-) —1 �/ i l 3 0` <br />