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CHAIN OF CUSTODY / LA.BORA*Y ANALYSIS REQUEST FORM Page <br />13 d l P,0.4 San Joaquin County P.0.921356 <br />qzl6iAlo tun P --- in CI -11a Q111fn 17n Qnvrmmpnfn CA 05s3A l,ab: 'BC Labs. Baltersf;eld <br />Project Name: North County LF, San Jonquin County <br />Anal sis <br />Requested <br />v <br />1st Qtr 2013 Leachate <br />Project Number: 139874 <br />0 <br />Report to: Sheila Richgols (916-565-4327) <br />w <br />x <br /><Sheila.Richgels@Shawgrp.coln> <br />cc Report: Jody Rhoades (916-565-4362) <br />-<(lyr <br />°r <br /><jody.rhondes@shawgrp.com> <br />w <br />4 <br />Z <br />H <br />Samplers Signature: <br />O <br />C <br />o <br />vi <br />x <br />Qo <br />tp <br />CS <br />U <br />w <br />H <br />v <br />U <br />REMATUCS <br />Sample <br />2013 <br />LAB <br />Sample <br />voAs <br />250 LPE <br />L LPE <br />250 LPE <br />250 LPE <br />500 LPE <br />I lContalnerTypes <br />NP <br />NP <br />HtJ03 <br />142504 <br />1fNO3 <br />Preservations <br />T.D. <br />Data <br />Time 1:D. <br />Matrix <br />•.,' ;;; < 1•ICI <br />L-1 <br />1-911 <br />ltv •-) <br />water <br />8 3 <br />1 <br />1 <br />1 <br />1 <br />1 <br />L-3 <br />i X3`1 Z <br />water <br />8 3 <br />1 <br />1 <br />1 <br />1 <br />l <br />L-4 <br />51ED -3 <br />water <br />8 3 <br />1 <br />1 <br />] <br />1 <br />1 <br />HK BY <br />DISTFiI <br />UTION <br />'U -OUT M <br />� <br />r � <br />C12 <br />RELINQUISHED Ill' <br />RECEIVED BY <br />RELINQUISHED BY <br />RECEIVED BY <br />TURNAROUND <br />REPORT REQUIREMENTS <br />REQUIREMENTS <br />x1 hr _45 hr _5 dny <br />X 1. Routine Report <br />ll. Report (includes DUP, MS <br />Sig re <br />Sign t re <br />Siggatpre <br />Slgn ure <br />16 1j/r�; <br />X <br />51midnrd 1-10-15 m,kiny drays) <br />Pruvida Verhnl Preliminary Rusulb <br />MSD, as required, may be <br />charged as samples) <br />Pria Nam�x <br />� <br />gd or <br />Pri N <br />Prin d Na�o� <br />Print d Name <br />' <br />i1L V�QI� � <br />SS <br />( 6Ss`J �i <br />(1. <br />Provldat*A-NPrOminaryReadls <br />Requened nepnrl oma: <br />Ili. Data Validation Report <br />(includes All Raw Data) <br />X RWQCB <br />(HDLs/PQLs/I RACL(I) <br />Firm <br />Shaw Environmental <br />1'im1p <br />!�C /- 14-T- <br />Pirntr%� <br />'✓C IL� <br />Cirm `/' <br />C Z-4 <br />Dalc(rlma , /p�, I '^ <br />DmcCrlmo JiM, 2 SDate/Time <br />f, <br />i 7 <br />RELINQUISHED IIY <br />RECEIVED IIY <br />Special Instruellons/Comments: <br />Report A•IDLs, PQLs, mrd Trace, <br />Nitrate -Nitrogen 11115 n 48 -hr hold. <br />BC Labs - Tina Green <br />4100 Atlas Court <br />Sign lure <br />Signature <br />0 CL`v--__. <br />Bakcrsficld, Ca 93308 <br />661-327-4911 / Px: 327-1918 <br />Printed Name <br />) <br />Printed Name <br />, �^ <br />c(QA'v <br />0.3 f- y� GENA <br />Ship via UPS Acct 965376 <br />� � <br />rl� LA -J) <br />T% <br />Pira, <br />-[,) C C- 653 <br />c [,�°t"_% <br />EDDs to 4snsan.tvnlermnn n sluuwgrp.conl> <br />Daleffimo 1-13-1-3 -133n <br />Datcrrime I ,76 <br />��L.�"'�•3'J3 a�I 35 <br />