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CHAIN OF CUSTODY/LABORATORY ANALYSIS REQUEST FORM Page_of_ <br /> P.O.# San Joaquin County P.O.#21356 <br /> ShO® 180 Promenade Circle Suite 320 Sacramento CA 95834 Lab: BC Labs,Bakersfield <br /> Project Name: North County LF,San Joaquin County Analysis Requested <br /> 3rd Qtr 2012 Lysimeters <br /> Project Number: 139874 <br /> Report to: Sheila Richgels P4 <br /> <Sheila.Richgels@Shawgrp.com> <br /> cc Report: Jody Rhoades(916-565-4362) o00 <br /> <jody.rhoades@shawgrp.com> V a <br /> w W <br /> Sampler's Signature: p 0 V' REMARKS <br /> U V <br /> Sample 2012 LAB Sample VOAs LPE o L 250, PE Container Types <br /> I.D. Date Time I.D. Matrix HCl NP 03 H2So Preservations <br /> VZ-01 water 6 31 1 <br /> VZ-02A/B Ovate 3 1 1 <br /> VZ-03AB to 3 1 <br /> VZ-04A/B w er 6 3 1 1 <br /> VZ-05A/B w 3 1 1 I <br /> VZ-06 water t3 I 1" 1 <br /> VZ-07 water 6 3 1 1 1 <br /> VZ-08 water \,6j 3 1 1 1 <br /> RELINQUISHED BY RECEIVED BY RELINQUISHED BY RECEIVED BY TURNAROUND REPORT REQUIREMENTS <br /> REQUIREMENTS X I. Routine Report <br /> Signature Signature Signature Signature 24 hr 4a hr _5 day II. 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 FAX Preliminary Results III.Data Validation Report <br /> Finn Firm Firm Finn Requested Report Date: (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 /> Report MDLs,PQLs,and Trace. BC Labs-Tina Green <br /> Signature Signature 4100 Atlas Court <br /> Bakersfield,Ca 93308 <br /> Printed Name Printed Name 661-327-4911/Fx:327-1918 <br /> Ship via UPS Acct 965376 <br /> Firm Firm <br /> EDDs to<susan.waterman@shawgrp.com> <br /> Date/Time Date/Time <br />