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CHAIN OF CUSTODY / LABORATORY ANALYSIS REQUEST FORM Page-of— <br /> r'1't' 12—�1i 2-\ <br /> 7 P.O.# San Joaquin County P.O.#21356 <br /> Sh0awe 180 Promenade Circle,Suite 320 Sacramento,CA 95834 Lab: BC Labs,Balcersneld <br /> Project Name: North County LF,San Joaquin County Analysis Requested <br /> 3rd Qtr 2012 Ground.Water <br /> Project Number: 139874 ` <br /> Report to:Sheila Richgels(916-565-4327) w <br /> <Sheila.Richgels@Shawgrp.com> a <br /> cc Report: Jody Rhoades(916-565-4362) ° °0°l <br /> <jody,rhoades@shawgrp.com> U U <br /> w <br /> -Q C0W <br /> Sampler's Signature: VO vJ Q RH]viARICS <br /> U G <br /> Sample 2012 LAB Sample "` VOA9 L. LPG 250 LPE 250 LPE ConininerTypes <br /> 1.D. Date Time I.D. Matrix ]tel Nr t-IN03 1.12son Preservations <br /> G-1 'y �7— water 6 3 1 1 l <br /> water 6 3 <br /> Z G-3D4 3 water 6 3 1 1 1 <br /> ?j 0-4 q 4A water 6 3 1 1 1 <br /> er <br /> y 0-6 1- \ ,17,17- water 6 3 l 1 1 <br /> ej Field Blank `7j N I)q water 2 2 <br /> ip <br /> Trip Blank '� jl /V16 water 2 2 <br /> RELINQUISHED BY RECEIVED BY RELINQUISHED BY RECEIVED BY TURNAROUND REPORT REQUIRE+NIENTS <br /> REQUIREMENTS X 1. Routine Report <br /> Sl re SI n t o Sign re ¢ Sign+lure 14br _49hr _5 day 11. Report(includes DUP,MS <br /> g ` Q kq A-Lj 5 X standard(-]o-t5 working days) MSD,as required,may be <br /> PH Mil <br /> Nam ) Prinl Name� / Prin[AName Printed Nnme / Prmide Yerbal Preliminary Reauh charged as samples) <br /> LL, W onb,10Tl- /�'-5- / QW ProvidePA.CPrellminnryResults 111,Data Validation Report <br /> Firm Firm Firm Ix Firm ) Requaaled Repan Dme: (includes All Raw Data) <br /> Shaw Environmental G �G 3 - X RwQCB <br /> Dalefrime l�-1~!� 2Q Datefrime !' (20DaIrMme Iv 11 Datefrimc (HDLs/PQLs/TRACE9) <br /> RELINQUISHED BY RECEIVED BY Special Instructions/Comments: <br /> Report NIDLs,PQLs,and Trace. BC Labs-Tina Green <br /> Sig lure notur 4100 Atlas Court <br /> Bakersfield,Ca 93308 <br /> Printed Nnme 7 Fyt/tte amc j 661-327-4911/Fs:327-1918 <br /> a ✓�Ut/ Ship via UPS Acct 965376 <br /> Firm ) 1 Firm n , <br /> )3 t` (�j� !� uL EDDs to<susnn.rvntermnn@shntivgrp.com-> <br /> Dale/Time <br />