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= = MMMMMMW * M MMM <br /> CHAIN OF CUSTODY / LABORATORY ANALYSIS REQUEST FORM . age—of- <br /> 4L 4} P.O.P.O.No: Direct Bill to the County <br /> SjjaW® 180 Promenade Circle Suite 320,Sacramento,Calif 95834 Lab: BC Labs, Bakersfield <br /> ProjectNalne: Harney Lane LF;San Joaquin County Anal sis Requested <br /> 1st Qtr 2012 Ground Water-Annual .Qa <br /> ProjectNumber: 139866 <br /> Report to: Sheila Richgels,Shaw Environmental <br /> <shelia.riellgels cr sllAwgrp.com> 916-565-4327 _� W <br /> CC Report to: Jody Rhoades,Shaw Environmental y <br /> <jody.rhoades r(7i sha-wgrp,com> 6-565-4362 0 z o °' <br /> Sampler's Signature: <br /> W p a v REMART(S <br /> Sample 2012 LAB Sample vons L.LPE a5o ml zso,n1 500 LPL' Container Types <br /> I.D. Date Time LD. Matrix JACt NP 112s04 luvo3 rtrio3 Prescrvadons <br /> MW-1 H- -17– d�i3 —� water 7 3 <br /> MW-2 2) -••L water 7 3 I 1 I 1 <br /> MW-3 �L7� '.3 water 7 3 1 1 ] I CHK B DI <br /> MW-,1 913 -4 water 7 3 1 I 1 1 <br /> MW-5 tj31" 'S water 7 3 1 1 t I 9U OUT <br /> MW-6 ` `U water 7 3 1 l l i <br /> Field Blank i^' water 2 2 <br /> 2 <br /> Tri Blankr•' j water 2 2 <br /> z <br /> ItELINQUI5fd);D BY RECEIVED BY RELINQUISHED BY RECEIVED BY TURNAROUND REPORT REQUIRENILNTS <br /> REQUIREMENTS X 1. Routine Report <br /> atur Sig r re I Signnt�re Signa ureL 241,r _aa iu i5 day 11. Report(includes DUP,MS <br /> X Standard(-10-15 working days) MSD,as required,may be <br /> Pri d Name Pri d Name Prin d Name Printed Name 1 Provide Verbal Preliminary Results charged as samples) <br /> U(� Urt <br /> C'711j1141��' SS< ' G {)SS ���� G�IZ . Provide FAXPralimimiryResults [II.Data(includes <br /> All <br /> RaRD to <br /> Firm Fi Film Firgh 4/ 451 Requested Report data: (includes A11 Raw Data) <br /> ShowEnvironmental '�/3 ,✓rit X R�VQCB <br /> bateflimef- �L ?.� Daterrime Z v batelrime 'y, 2 Dote/Time I-/9-Jrz /, DS <br /> {MDC.s/PQLs/TRACE#) <br /> RELINQUISHI D BY RECEIVED BY Special Instructions/Comments; Container Types Key: <br /> DC Labs-Tina Green 40 ml VOA: I <br /> fit <br /> Si 1 Plense report AIRL's,PQL's and Trace. 4100 Atlas Court 250 m]LPE: 2 <br /> Nitrate-Nltragen ltns n A8-hr hold time. Bakersfield,Ca 93306 50l]ml LPE: 3 <br /> Printed Name Printed No 661-3274911 IF-,: B 1 liter HDPE: 4 <br /> �R l� (( �,•I.� Ship vin UPS Acct t 96537b65376540 ml glass: 5 <br /> Firm BC Lab Caurler: 1 liter glass: 6 <br /> F, .C�,/f1✓J� 6(- WDs to<susan,wntennnn@s)tawgrp.cam> Ross Dickey Qa 661-201-4171 2x6 s/s ring: 7 <br /> D�atc/Timc /,� Date rimc •-1 -1 i' q glass jar. & <br />