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CHAIN OF CUSTODY / LABORATORY ANALYSIS REQUEST FORM Page _ of _ <br />Shaw Environmental, a CB1 Company P.O. No: Direct Bill to the County <br />9&T.ah• RC T.ahs. Bakersfield <br />180 Promenade urcie quite l,cu oacrarueAli►v <br />Project Name: Harney Lane LF, San Joaquin County <br />1st Qtr 2014 Surface Water - Annual <br />Project Number: 149273 <br />Report to: Sheila Richgels <br /><simeila.richgels@CBI.com> 916-565-4327 <br />Sampler's Signature: <br />`.attx 7_»l- <br />Analysis <br />Requested <br />6 o0 <br />o E� <br />U Uj oz <br />4-4 <br />°' <br />n 0N0 <br />a r� <br />A <br />:d <br />ov v <br />a� <br />REMARKS <br />Sample 2014 <br />I.D. Date <br />S-1 <br />LAB <br />Titne I.D. <br />Sample <br />Matrix <br />water <br />Vons <br />L. LPE <br />250 ml <br />250 tnl <br />500 LPE <br />Container Types <br />HCl NP <br />7 3 1 <br />H2SO4 HNO3 <br />1 1 <br />HNO3 <br />1 <br />Preservations <br />S-2 <br />water <br />7 <br />RELINQUISHED BY <br />RECEIVE Y <br />RELINQUISHED BY <br />Signature <br />- <br />Printed Name <br />Firm <br />Date/Time <br />RECEIVED BY <br />Signature <br />Printed Name <br />Firm <br />Date/Time <br />X <br />TURNAROUND <br />REQUIREMENTS <br />24 hr 48 hr 5 day <br />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/TRACEH) <br />Si nature <br />g <br />Sigliature <br />Printed Name <br />Paul Weinhardt <br />Printed Name <br />Firm <br />CBI <br />Date/Time <br />Firm <br />Date/Time <br />RECEIVED BY <br />Special Instructions/Comments: <br />Please report MRL's, PQL's and Trace. <br />Nitrate -Nitrogen has a 48 -hr hold time. <br />BC Labs -Tina Green <br />4100 Atlas Court <br />Bakersfield, Ca 93308 <br />661-327-4911 / Fx: 327-1918 <br />Ship via UPS Acct 965376 <br />BC Lab Courier: <br />Ross Dickey Q 661-201-4171 <br />RELINQUISHED BY <br />Signature <br />Signature <br />g <br />Printed Name <br />Printed Name <br />Fir"] <br />Firm <br />Date/Time <br />Date/Time <br />