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CHAIN OF CUSTODY / LABORATORY ANALYSIS REQUEST FORM Page _ of <br />Shaw Environmental, a CB1 Company P.O. No: Direct )Bill San Joaquin County <br />° IRO Promenade circle. Suite 320. Sacramento. 1`A 95R34 T.ah• RC T.ahc R�lrnrcl;nlA <br />Project Name: Foothill Landfill, San Joaquin County <br />I st Quarter Sampling 2014 <br />Project Number: (Leachate) <br />Report to: Sheila Richgels <br /><sheila.richgels@Cl3I.com> 916-565-4327 <br />Sampler's Signature: t <br />Analysis <br />Requested <br />y <br />iv n <br />yg till <br />u <br />x <br />o <br />L <br />x .a <br />6' <br />V <br />'z <br />. �' <br />o w <br />REMARKS <br />Sample 2014 LAB Sample <br />I.D. Date Time I.D. MatrixMNP <br />LLPE <br />250ml <br />500ml <br />VOA <br />Container Types <br />NP <br />I-IN03 <br />HCl <br />Preservations <br />L-01 d944 g% �� water <br />6 1 <br />1 <br />1 <br />1 3 <br />+G Kin. SS <br />CHKBY <br />RELI UISHED BY <br />RECEIVED BY <br />RELINQUISHED BY <br />RECEIVED BY <br />TURNAROUNDTIM <br />REQUIREMENTS <br />24 hr _48 hr __5 day <br />X Standard (-1e-15 working days) <br />Provide Verbal Preliminary Results <br />Provide CA7C Preliminary Results <br />Requested Report Dare: <br />`t'-RI;KQFI• <br />X I. Routine Report <br />11. Report (includes DUP, MS <br />MSD, as required, may be <br />charged as samples) <br />III. Data Validation Report <br />(includes All Raw Data) <br />X RWQCB <br />(MDLs/PQLs/TRACE#) <br />Si re <br />Sign re ' <br />�L <br />Sign ire % <br />pad p�` <br />Signa t�o <br />M-G-L't, <br />Printed Name <br />Paul Weinhardt <br />Pr'lf d Named <br />/ i @S$ E� �1(} <br />MINName <br />t <br />Pr' ed Name <br />(` <br />Firm <br />CBI <br />Firm <br />13= <br />Firm <br />, <br />Firm 1'7 % ! <br />/(t) C <br />Date/Time 0 1 <br />Date/ Time , < / d( <br />Daterrimc .,�4 • t'-/ i- <br />Date/Time - <br />RELINQUISHED BY <br />RECEIVED BY <br />Special Instructions/Comments: <br />BC Labs - Tina Green <br />Please report MDLs, PQLs and Trace. 4100 Atlas Court <br />Nitrate -Nitrogen has a 48 -hr (told time. Bakersfield, Ca 93308 <br />661-327-4911 / Fx: 327-1918 <br />Ship via UPS Acct 965376 <br />Courier: Ross 661-201-4171 <br />Container Types Key: <br />40 mi VOA: I <br />250 ml LPE: 2 <br />500 mi LPE: 3 <br />1 liter HDPE: 4 <br />500 ml glass: 5 <br />1 liter glass: 6 <br />2x6 s/s ring: 7 <br />glass jar. 8 <br />Sign pr <br />'ifo <br />Signature <br />G <br />Pr ed Name 1 <br />2 <br />Printed Name <br />OSE. <br />Firm <br />- <br />Firm <br />13 ('�„ f,) <br />Mat rime .30 <br />Date/Time Z <br />