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M ® ® M M M M ® M M ® M M M <br />CHAIN OF CUSTODY / LABORATORY ANALYSIS REQUEST FORM Page _of_ 7 <br />Direct bill to San Joaquin County <br />— <br />R hem• {ni tA0 Promenade Cirrle_ Rune 320. Rncrnmentn_ Cn 95834 'T�-'-^f-i-i-� � ' fz • D t e'2-Jr_S T.nht RC I .nhc Rnitrrcf;rid -* <br />Project Name: Corral Hollow LF, Son Joaquin County <br />Analysis <br />Re uested <br />1st Qtr 1011 Ground Water <br />Project Number: 139881, <br />T101 <br />Report to: Sheila Rlchgels, Shaw Environmental <br />tu <br />CCK Y <br />�,e <br /><sheilu.rieligels@sllawgrp.com> 916-565-4327 <br />a <br />CC Report to: Jody Rhoades, Shaw Environmental <br />o <br />= °' <br />�' <br />a FSU OUT <br /><jody.rhoades@a shawgrp.com> 916-5 -4362 <br />L) <br />ai <br />O arm <br />E r� <br />G <br />y <br />2 <br />ry W <br />Sampler's Signature: <br />0 Q <br />o <br />00 <br />t m <br />U <br />z U <br />ii <br />w <br />I IREMARKS <br />Sample 2012 LAB Sample <br />LLPE <br />250mt <br />Vons 5001n1 <br />lContainerTypes <br />I.D. Date Time T.D. MatrixNP <br />NP <br />1­10HMW <br />Prescrvulions <br />MWA 11-Z5.17-Wq water <br />G,,. 1 <br />1 <br />3. 1 <br />MW -5 10u water <br />6 1 <br />1 <br />3 1 <br />SB -1 �31r water <br />6 1 <br />1 <br />3 1 <br />MW -6 civi y water <br />6 1 <br />1 <br />3 1 <br />MW -7 b water <br />G 1 <br />1 <br />1 3 I <br />N T ME <br />MW -8 3 ' (D water <br />6 1 <br />1 <br />3 1 <br />r+e NO.*0-)p SS <br />Field Blank water <br />2 <br />2 <br />Ci Op N BAS COT <br />Trip Blank N111 water <br />2 <br />2 <br />RELINQUISHED BY RECEIVED BY <br />RELINQUISHED BY <br />RECEIVED BY <br />TURNAROUND REPORT REQUIREMENTS <br />REQUIREMENTS X 1. Routine Report <br />as lit hr Joy 11. Report (includes DUP, MS <br />Signal r Sig a rr aSig <br />ure <br />Signature <br />q r <br />_de ug <br />X grandard (-10.15 rvorking dnyej MSD, as required, may be <br />Provide vrrbel Prcllonory Rnuhr charged as samples) <br />Pr' i •d Nom rin�ta Na.. <br />ri d Nn <br />Printed Na a <br />�� ilS� <br />Provide FAX Prelhninnry nnsulis til, Data Validation Report <br />Regnr and xrPrn nme: (includes All Raw Data) <br />Firm Finn j <br />Finn �j �` <br />Pinnr <br />Slaw Environmental <br />/7c b <br />X RWQCB <br />(MDLs/PQIsf1RACEfl) <br />Do1errime Z Dntc/rimc <br />Onlelrime / <br />Dat (me /- / <br />RELINQUISHED BY RECEIVED BY <br />Special Instruc0ons/Comments: <br />Container Types Key: <br />Please report &IDLs, PQLs, and Trace. BC Labs -Tina Green <br />d 100 Atlas Court <br />40 ml VOA: I <br />250 nil LPE: 2 <br />Sig o ure naq� <br />0 Jim <br />Nitrate Nitrogen has n 48 -lir IiOLD TIME. Bakersfield, Ca 93308 <br />661-327-4911 / Fa:327-1418 <br />500 in LPC: 3 <br />I Hier HDPE: 4 <br />Printed nm Pcitned ome <br />**** Incl m,p-xylene & o-xylana In 8260 results. Ship vin UPS Acct96S376 <br />BC Lab Courier: <br />500 ml glass: 5 <br />I titer glass: 6 <br />Firm ) Firm / dd � <br />Ross Dickey a 661-201-4171 <br />2x6 s1s ring: 7 <br />jar: 8 <br />Dmerrime -/ /7 on IDIC(tublass <br />rC, -t "• x.23 . �� : - L_- 6 0 0 (016 59�P� <br />10 <br />