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® r ® ® ® ® = ® ® ® M = = ® ® ® = <br />CHAIN OF CUSTODY I LABORATORY ANALYSIS REQUEST FORM Page _ of <br />Shaw Environmental, a CBI Company P.O. No: Direct Bill San Joaquin County <br />dh IRO Promenade Circle. Suite 320. Sacramento. CA 95834 Lab: BC Labs. Bakersfield <br />Project Name: Foothill Landfill, San Joaquin County <br />Analysis Re uested <br />1st Quarter Sampling 2014 <br />Project Number: 149269 (Ground Water) <br />o <br />Report to: Sheila Richgels, CB&I <br />a M <br />v <br />ro .. <br /><sheila.richgels@CBI.com> 916-565-4327 <br />m00 <br />v <br />U <br />4. <br />a2 <br />� <br />Sampler's Signature: <br />o A <br />Z > E~ <br />¢ <br />v <br />..::. <br />L. <br />REMARKS <br />Sample 2014 LAB Sample <br />von Liter <br />LPE <br />250tn1 <br />500tni <br />Container Types <br />I.D. Date Time I.D. Matrix <br />HCI <br />NP <br />NP <br />HNO3 <br />Preservations <br />MW -IA k, -LO TI0 water <br />6 3 <br />1 <br />1 <br />1 <br />MW -2R k,2-0 JiA"'- -'z water <br />6 3 <br />1 <br />1 <br />1 <br />MW -3 Z-$ water <br />6 3 <br />1 <br />1 <br />I <br />MW -4. 1,2A R50 water <br />6 3 <br />1 <br />1 <br />1 <br />_ <br />7111nE <br />MW -5 $ ��® �° - mater <br />6 3 <br />I <br />1 <br />1 <br />e Np , NO, <br />P SS <br />LW -1 VIN water <br />6 3 <br />1 <br />I <br />1no <br />> <br />Field Blank water <br />2 2 <br />Trip Blank water <br />2 2 <br />iS <br />RE QUISIIED BY <br />RECEIVEDSY - <br />RELINQUISHED BY <br />RECEIVED BY <br />TURNAROUND REPORT REQUIREMENTS <br />REQUIREMENTS X I. Routine Report <br />24 hr 45 hr _5 day II, Report (includes DUP, MS <br />i m <br />Si� Lure <br />5i �iure <br />Signatu a <br />I <br />/G �� , ,: <br />pad <br />�+ <br />X <br />Standard (-10-15 working days) MSD; as required, may be <br />Provide verbal Preliminary Results charged as samples) <br />-ICPrinted Name <br />PrtVefi Nam <br />Pn d Name <br />Pri ed Name <br />Paul Weinhardt <br />/ Le+s S [ <br />J C �� S <br />[ a <br />Provide FAX Preliminary Results IIi. Data Validation Report <br />Requested Report nate: (includes All Raw Data) <br />Finn <br />Firm ,. <br />3c <br />Firm <br />Firm f <br />CB1 . <br />� <br />8C <br />3 <br />C V'f'/ <br />X RWQCB <br />(MDLs/PQLs/TRACE#) <br />Daterrime d 0 <br />Date/Time l 4M <br />Date/Time I -)-/N 1 y <br />Date/Time -I <br />RELINQUISFIED BY <br />RECEIVED BY <br />Special instructions/Comments: <br />Please report MDLs, PQLs and <br />Trace <br />BC Labs - Tina Green <br />4100 Atlas Court <br />Sig atre <br />Signature <br />d1✓ <br />6 <br />Nih ntc iVitrogetr <br />has:;n 48 lir hold <br />time <br />Bakersfield, Ca 93308 <br />661-327-4911 / Fx: 327-1918 <br />Prt d Nam <br />Printed Name <br />S® <br />Ship via UPS Acct 965376 <br />'Courier: Ross 661-2014171 <br />Firm <br />Firm <br />5 QLJ&5 <br />n r <br />Dtutirn. —,. — <br />Date/Time <br />I ',� 1•1/t- 1-1 -vt vv <br />®. <br />