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� M M ® ® M M ® M M ® M w ® w ® ® w <br />CHAIN OF CUSTODY / LABORATORY ANALYSIS REQUEST FORM PageIMP <br />P.O. Direct bill to San Joaquin County 7 <br />eft 190 Prnma+nnrle Cirele. Sulfe 320- Sacramento- Ca 95834 � �.'�" �r� � i.ah• Ttl•-' i.nhe Ilntrli <br />nrcnld ' 0 <br />� <br />Project Name: Corral Hollow LF, San Joaquin County <br />Analysis Re uesled <br />4th Qtr 2013Ground Water Sampling <br />Project Number: 149271 <br />H <br />Report to: Sheila Richgels, CB&I <br />m <br />4 <br /><shelln.rlchgels@CB1.com> 916-565-4327 <br />.7 <br />:2 <br />,v <br />_S <br />B <br />u <br />d <br />u LtI <br />Z <br />A,,J <br />*� <br />Z <br />�,, <br />N <br />C t>D <br />Q'p <br />� W <br />C `� <br />d <br />'r� V <br />Sampler's Signature: <br />8 <br />m <br />o Q <br />?; <br />s o <br />G Y <br />ter] <br />t d <br />¢ `p <br />U <br />REMARKS <br />Sample 2013 LAB Samp a <br />L. LPE <br />250 <br />LPE 40m1 <br />VOAs <br />Fmm 1.1`11 <br />somal <br />Container Types <br />LD. Date Time LD, Matrix <br />NP <br />NP <br />HCI <br />NP <br />FIN03 <br />Preservations <br />MW -4 —i 104'1 <br />water <br />5 <br />1 <br />1 <br />3 <br />MW -5 —a 1iDM1 water <br />6 <br />1 <br />1 <br />3 <br />XX <br />1 <br />SB -1 — -2water <br />5 <br />1 <br />1 <br />3 <br />MW -6 -` ( <br />water <br />5 <br />1 <br />1 <br />3 <br />4 r <br />FilL Thr )IN <br />iu <br />MW -7 water <br />5 <br />l 1 3 <br />MW -8 <br />water <br />5 <br />1 <br />1 <br />3 <br />MW -9A '1 3Z- <br />water <br />5 <br />1 <br />1 <br />3 <br />a1g <br />MW -10A <br />water <br />5 <br />1 <br />I <br />3 <br />5 U <br />I <br />Qcz <br />MW -11A Bal <br />wafer <br />5 <br />I <br />1 <br />3 <br />Field Blank tD f} <br />water <br />2 <br />1 <br />2 <br />,_t <br />Trip Blank '�� !��%� <br />water <br />2 <br />17 <br />RELINQUISHED BY <br />RECEIVED BY <br />RELINQUISHED BY <br />RECEIVED BY <br />TURNAROUND <br />REPORT REQUIREMENTS <br />REQUIREMENTS <br />±a hr dey <br />X I. Routine Report <br />IL Report (includes DUP, MS <br />S lur <br />Sig re <br />Signature <br />Signature <br />4 <br />X <br />_48h, _s <br />SmnJenli-Ie-IS,vmldngJoys) <br />Provide V�hei Pmsmiea yaenm, <br />MSD, as required, may be <br />charged us samples) <br />Prigo Namc� <br />Prinicd Nnnn <br />Printed Name <br />Printed Name <br />vL, p ?91z <br />�- n Pr <br />Provide PAxPmlimhm,y Remo. <br />amu.:mJ Repan Dom <br />III. Dutra Validation Report <br />(includes All Raw Data) <br />Finn <br />Firm % <br />Firm <br />Finn <br />C&gl <br />,, <br />tq-b <br />X RWQC13 <br />(MDLs/PQLsfrRACE11) <br />D0tc/T(mc 0,L /3 <br />Ditirrrimc -/ -1 ,jt U <br />Dalerrimc <br />DateMnre <br />RELINQUISIIED BY <br />RECEIVED BY <br />Special Instroctions/Commenis: <br />Please report 11IDLs, PQLs, <br />and Trace. <br />13C Labs - Tina Green <br />4100 Atlas Court <br />Signal tt <br />Signature <br />II ry�� <br />Nitrile Nitrogen <br />has a 48 -hr <br />hold <br />time. <br />Bakersfield, Ca 93308 <br />661-327-4911 / Fx: 327-1918 <br />Printed Name <br />Pri ed Nome <br />�05� <br />P" �- 4 P <br />� n} <br />**** Incl <br />m,p-xylene & <br />o -xylene <br />in 8260 results. <br />Ship via UPS Acct 965376 <br />AC Courier: <br />Finn <br />Finn <br />,b <br />U <br />Ross Dickey @ 661-201-4171 <br />Date/?'in,c ( - -13 <br />Datelrime 10 <br />t)tiEl--- tea lC+'I t-t3..0!A5 KrY`r 10-1-7_13 a0a5 <br />w <br />C <br />CL <br />a <br />O_ <br />Q <br />1 <br />0 <br />m <br />a <br />m <br />0 <br />0 <br />w <br />N <br />4 <br />W <br />Ca <br />00 <br />