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CHAIN OF CUSTODY / LABORATORY ANALYSIS REQUEST FORM Page _ of <br />P.O. Direct bill to San Joaquin County <br />�1a®Al® , on n..,..,, A r. -I- c ... fo zln re, QFRAA T.ah RC T.ahc. Rnkercfield <br />ProjectName: Corral Hollow LF, San Joaquin County <br />2012 Surface Water <br />Project Number: 139881 <br />Report to: Sheila Richgels, Shaw Environmental <br /><sheila.richgels@shawgrp.com> 916-565-4327 <br />CC Report to: Jody Rhoades, Shaw Environmental <br /><jody.rhoades@shawgrp.com> 916-565-4362Z <br />Sampler's Signature: <br />Anal <br />sis <br />Requested <br />d <br />o c <br />w N <br />U 4 <br />O bj <br />b <br />o0 <br />a <br />o <br />V o ° <br />o <br />U <br />REMARKS <br />Sample 2012 LAB Sample <br />I.D. Date Time I.D. Matrix <br />40ml VOAs <br />L LPE 250 LPE <br />500 LPE <br />Container Types <br />HCl <br />NP NP <br />tits <br />Preservations <br />SW -1 water <br />6 3 <br />1 <br />1 <br />SW -2 water <br />6 N.1 <br />1 <br />1 <br />RELINQUISHED BY <br />RECEIVED B <br />RELINQUISHED BY <br />RECEIVED BY <br />TURNAROUND <br />REQUIREMENTS <br />24 hr _48 hr 5 day <br />X Standard (-10-15 working days) <br />Provide Verbal Preliminary Results <br />Provide FAX Preliminary Results <br />Requested Report Date: <br />REPORT REQUIREMENTS <br />X I. Routine Report <br />II. Report (includes DUP, MS <br />MSD, as required, may be <br />charged as samples) <br />III. Data Validation Report <br />(includes All Raw Data) <br />X RWQCB <br />(MDLs/PQLs/TRACE#) <br />Signature <br />Signati <br />Signature <br />Signature <br />Printed Name <br />Printed Name <br />Printed Name <br />Printed Name <br />Firm <br />Shaw Environmental <br />Firm <br />Firm <br />Firm <br />Date/Time <br />Date/Time <br />Date/Time <br />Date/Time <br />RELINQUISHED BY <br />RECEIVED BY <br />Special Instructions/Comments: <br />BC Labs - Tina Green <br />Please report MDLs, PQLs, and Trace. 4100 Atlas Court <br />Nitrate Nitrogen has a 48 -hr hold time. Bakersfield, Ca 93308 <br />661-327-4911 / Fx: 327-1918 <br />**' * Incl m,p-xylene & o -xylene in 8260 results. Ship via UPS Acct 965376 <br />BC Lab Courier: <br />Contact Tina <br />Container Types Key: <br />40 ml VOA: 1 <br />250 ml LPE: 2 <br />500 ml LPE: 3 <br />1 liter HDPE: 4 <br />500 ml glass: 5 <br />1 liter glass: 6 <br />2x6 s/s ring: 7 <br />glassjar: 8 <br />Signature <br />Signature <br />Printed Name <br />Printed Name <br />Firm <br />Firm <br />Date/Time <br />Date/Time <br />