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CHAIN OF CUSTODY/LABORATORY ANALYSIS REQUEST FORM Page_of <br /> ® P.O.# San Joaquin County P.O.921356ShQc <br /> 180 Promenade Circle Suite 320 Sacramento,CA 95834 53 Lab: BC Labs Bakersfield c 0 <br /> a. Project Name:North County LF,San Joaquin County Analysis Requested <br /> Ist Qtr 2012 Ground Water M 3 <br /> y Project Number: 139874 o a 9 <br /> CD <br /> Report to:Sheila Richgeis(9:16-565-4327) m <br /> <Sheila.Richgels@Shawgrp cnm> <br /> b cc Report: Jody Rhoades(916-565-4362) o �; a nn y n N <br /> o ? <Jody.rhoades@shawgrp.com> w W epn d B Z o m <br /> D n o G h C .� � a4 +-• fp r <br /> " .>D arU no 0 <br /> Sampler's Signature: U <br /> c w <br /> U <br /> tis <br /> A a H° tD U REMARKS 4 <br /> W n Sample 2012 LAB Sample vom 250 LPE L LPE 250 LPS 250 LPE 500 LPE Container Types <br /> 01 S I.D. Date Time T.D. Matrix rta Nr Nr wrto3 H250J HNO3 Preservations TI $ <br /> 0 t' <br /> a r G-1 t-4.12 121b water 8... 3 1 1 1 1 1 3 A <br /> w , to <br /> C1. _ water o <br /> m o —� G-3D 1-10.1z O� water 8 3 1 1 1 1 1 N <br /> w G4 1-10=17. 1 D°1 water 8 3 I 1 1 1 1 0 <br /> rr <br /> CD aw <br /> -�Ll G-6 ,-10=I2lttz water 8 3 1 i i 1 1 <br /> N Field Stank lit®alt N water 2 2 +erip Sa' <br /> vws <br /> TH2 Blank I-ID-12 N water 2 2 s <br /> � n <br /> _ !R e 0 <br /> y <br /> -n �� RELINQUISHED BY RECEIVED BY RELINQUISHED BYC RN,ROUND REPORT REQUIREMENTS N <br /> X _ SUB-0 JT l Y-ran.�r.,QUl REIKENTS X 1. Routine Report <br /> o? v Sign re Sig re Signature ure 74 hr - as hr _5 day M Report(includes DUP,MS <br /> a6� Y�F t•G �� X standard(-i&-oworkinadays) MSD,as required,may be <br /> � Q Pri t Namc Pri d Nome Printed Name Printed Name ) Pr ida Varbat Pmihniwry naada charged as samples) <br /> c o 1rL �Q11�1ij�T3 c+ VbSS f nAP f ,��19-A rr id,PAX PW1W ryn—wta Ill.Data Validation Report <br /> OD a Firm Litm Fiyyr��m // �� Firm / L Ras�oeatadMp rlDuc (includes All Raw Data) <br /> Sltaty Environmental 136l'J'L', /3 C C�bs �_x RWQCB <br /> a <br /> °a y Daic/Timc I^IO-1= j�3 Daterrime -/0 / bnte/I ime/./p•' , Dmerrime/-/ -/a /. O (MDLs/PQLs/rRACEA) <br /> c RELINQUISHED BY RECEIVED BY Special Instructions/Comments: Container Types Key: <br /> o Report 1VIDLs,PQLs,and Trace BC Lobs-Tion Green 40 ml VOA: I <br /> 3 y °a Si lure S' atu Nitra[e-Nitrogen Inns n 48-Itr hold. 41D0 Atlas Court 250 ml LPE: 2 <br /> 2 © 1L Bakersfield,Ca 93308 500 nit LPE: 3 <br /> Printed Name , P'ntcd.ry�me 561-327-0911/Pa:327-L918 I liter HDPE: 4 <br /> 1_z�6 A;�J C,K-t: o Sl <br /> Ship vin UPS Acct 965376 500 ml glass: 5 <br /> ^ A Firm Pirm 1liter glass: 6 <br /> a3 S EDDsto<susan.wotermnn(ashowgrp.com> 2x6s/sring: 7 <br /> -/ <br /> y DotcMme 0-/2- /(1C) D t '-kms glassiar. 8 <br /> R <br /> o <br /> 0 <br /> � a <br /> CD <br /> d <br /> to <br /> 0 <br /> 0 <br />