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CHAIN OF CUSTODY.' / LABORATORY ANALYSIS REQUEST FORM Page,_of_ <br />Shaw Environmental, a CBI Company P.O. No: Direct Bill to the County <br />dh 180 Promenade Circle. Suite 320. Sacramento. Calif 95834 T.ah• R(' T.ahs Ral�u,•c fiatrl <br />Project Name: Harney Lane LF, San Joaquin County <br />Anal sis <br />Requested <br />Ist Qtr 2014 Ground Water - Annual <br />o <br />Project Number: 1.49273 <br />Report to: Sheila Richgels <br /><shella.ricllgels@CELcom> 916-565-4327 <br />o <br />H <br />a <br />h <br />U <br />QvQ) <br />en <br />ro <br />Sampler's Signature:il b <br />e <br />a z <br />oli <br />x <br />J <br />® J <br />a <br />� <br />5 <br />U _ <br />REMARKS <br />Sample <br />2014 <br />LAB Sample <br />voAs <br />L. Lee 250 mi <br />250 ml <br />500 LVE <br />Container Types <br />l,D, <br />Date <br />Time I.D. Matrix <br />= <br />Hcl <br />NP WSO4 <br />HNO3 <br />HNO3 <br />aliens <br />j MW -1 <br />wko.Lr-i <br />vs,- water <br />7 <br />3 <br />1 1 <br />1 <br />1 <br />SHOT <br />HOLDING IM <br />-2 MW -2 <br />water <br />7 <br />3 <br />1 1 <br />1 <br />I <br />r IO2 <br />N of, <br />SS <br />,3 MW -3A <br />b�t0'1 water <br />7 <br />3 <br />I 1 <br />1 <br />1 <br />O CI BOD MEAS COT <br />.-L MW -4A <br />Chowater <br />7 <br />1 3 <br />1 1 <br />1 <br />1 <br />MW -5 <br />�✓t water <br />7 <br />3 <br />1 1 <br />1 <br />1 <br />- <br />-{p MW -6 <br />I° water <br />7 <br />3 <br />1 1 <br />1 <br />1 <br />CHK Y <br />is I FM- <br />OF1 <br />-i Field Blank <br />N water <br />2 <br />z <br />-$ Trip Blank <br />water <br />2 <br />2 <br />RELINQUISHED BY <br />RECEIVED BY <br />RELINQUISHED BY <br />RECEIVED BY <br />TURNAROUND <br />REPORT REQUIREMENTS <br />REQUIREMENTS <br />24 hr —48 hr _5 day <br />X 1. Routine Report <br />11. Report (includes DUP, MS <br />Signo <br />Sig l ire <br />Sigi i (� <br />Sig <br />j <br />l <br />v R <br />X <br />stands (-10- 15 ,vorking days) <br />Provide verbal Prelinduary Results <br />MSD, aS regUired, ala}' be <br />charged as samples) <br />Printed Name <br />Pri,l� (I Nallie•� ` <br />PriAd Nall <br />Printed Name / , ] <br />Paul Weinhardl <br />/<,a -CS F,_J <br />f1 (=1 � t t' <br />-/ (J E}(ow f" <br />Provide FAX Preliminary Results <br />Requested Report Uate: <br />111. Data Validation Report <br />(includes All Raw Da(a) <br />Finn <br />Finn q� <br />Firm <br />Finn %.1C / <br />/ ✓ b <br />CBI <br />JCC � � <br />X RWQCB <br />MDU/P Ls/l'RACEN) <br />Dole/rime , lw!(/ 0� <br />DnlefTDue , / <br />Dntefrime!r 6`( <br />Datefrime I—(164y 7 <br />RELINQUISHED BY <br />RECEIVED BY <br />Special [nslrut lona/Conunenfs: <br />Please report MRL's, PQL's <br />anti <br />Trace. <br />BC Labs - Tina Green <br />4100 Atins Court <br />Sign u e <br />Slgnatur <br />lj <br />Nitrate-Nih•ogen hiss n 48 -hr <br />hold <br />time. <br />Bakersfield, Cn 93308 <br />661-327-49111 Fx: 327-1918 <br />printed Name <br />Printed Nante <br />GjkR—Y <br />A g $£ rrLC,;r � <br />Ship via UPS Aoct 965376 <br />BC Lab Courier: <br />First <br />First <br />/� C_ <br />Ross Dickey ® 661-201-4171. <br />Dntefrinie _1 ,j <br />Date/1'ime L <br />Ki✓ L..( O k -t 6 I y eo—= i -I cp (4 aP b <br />