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n <br /> CHAIN OF CUSTODY/LABORATORY ANALYSIS REQUEST FORM Page—of— w <br /> a ® 12-W(-\VL' P.O.# San Joaquin County P.O.#21356 <br /> a� <br /> a'1 180 Promenade Circle Suite 320 Sacramento,CA 95834 Lab: BC Labs,Boltersfield n <br /> m <br /> ProjectName:North County LF,San Joaquin County Anal sis Requested H <_' <br /> a 1st Qtr 2012 Leachate I p A <br /> y ProjectNumber: 139874 o .CL m <br /> Report to: Sheila Richgels(916-565-4327) u o = d <br /> <Shelin.Riehgels®Shawgrp.com> e o -i <br /> a cc Report: Jody Rhoades(916-565-4362) c �1 of y n M�. o <br /> o <jody.rhoades sllawgrp.cum> o W be Z o ,o <br /> rr <br /> bn <br /> 4j <br /> LUJ <br /> cc) Cc, <br /> Sampler's Signature: - 5 V1250 <br /> o Lo �€ A <br /> o p g > v A w F �U U REMARKS <br /> w ; Sample 2012 LAB Sample r s VOALPE L LPE 290 LPE 290 LPE 500 LPE Container Types <br /> I.D. Date Time I.D. MatrixuCi NP NP HNO3 1-12sod HNO3 lPreservations c 8 (� <br /> water > 8 3 1 1 1 1 1 <br /> a o cc <br /> Z L-3 �i?�W water S 3 1 1 1 l 1 i o <br /> DL-4 �DQ� water S 3 1 1 1 1 1 <br /> ry <br /> � W 01 <br /> CA) <br /> p IL- SHOR H01 G Tf 1 <br /> lay e r I . w <br /> w. <br /> 4 V, C Cl, BOD MBAs c S <br /> IR a -_.'.._ .._ O <br /> -yn RELINQUISHED BY RECEIVED BY RELINQUISHED BY RECEIVED BY TURNAROUND REPORT REQUIREMENTS N <br /> X g <br /> REQUIRE IlIENTS X 1. Routine Report <br /> Sig ire SI a rc Sig Pro ^ Signoture 24br _44hr _sa4y II. Report(includes DUP,MS <br /> �� iV-�[/� ,�• �2c+r�- X Sundard(-10.19--,vorYing day)) MSD,as required,may he <br /> w , <br /> 4 x Prin! Nomc / Prigt Nam Pri ed Name Printed Name r� Pmdde Ve bolP eliminoryRmulu charged as samples) <br /> '� yg UL "j or / �crx D /1y .(JO(f4 .) 11—id.rAXP.161nnryA..Iu 111.Data Validation Report <br /> mfg <br /> eo Firm FI Firm �) Fin^7n C L� L C neqnes,oa ncPen nme: (includes All Rase Dora) <br /> Ilk Shaw Environmental / J /JJ X RWQCI3 <br /> p° o Daterrime I- `!2 Dale/rime 1•9- Z QS` Dole rime Z i bntclrimc/-)r-/;L 6'3O (MDLs/PQLsrrRACE#) <br /> $ RELINQUISHED BY RECEIVED BY Special Instrudlans/Comments: Container Types Key: <br /> mReport MDLs,PQLs,and Trace. HC Latis-Tina Green 40 ml VOA: 1 <br /> 1 Sig tore Statute Nitrnte-Nlirogen has a 48-hr hold. 4100 Altus Court 125 ml LPE: 2 <br /> 3 ,� y _ BokcrAcld,Ca 93308 500 ml LPE: 3 <br /> n Printed Namo Printed N me 661-327-4911/Px:327-1918 1 lhcr HDPE: 4 <br /> Ship via UPS Acct 965376 500 nil glass: 5 <br /> CL Firm lass: 6 <br /> ` ^ L Firm I lilerg <br /> C Iy EDI)s to<susnnsvntcrmnushmvgrp.cam> 2x6 s/s ring: 7 <br /> Ditcrrinie / /7'C Dn 7P( c1 I'Z I glass'ar; 8 <br /> AL <br /> Y ��It 7+t/ a-'"S,/ <br /> 1\ <br /> O <br /> w <br /> m <br /> w <br /> O <br /> N <br /> O) <br />