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a <br />b <br />M M M M = ® = = M = M = ® = <br />CHAIN OF CUSTODY / LABORATORY ANALYSIS REQUEST FORM Page _ of— <br />A a.. Shaw Environmental, a CBI Company P.O. No: Direct Bili to the County <br />tan PrompriafIP (+help- Sal1P 370-.S'arrnmenfn. Calif 9SR34 Lnh' RC. LahA- RAkerQtlPlrt <br />Project Name: Harney Lane LF, San Joaquin County <br />Analysis Requested <br />r; <br />5 <br />1st Qtr 2014 Ground Water - Annual <br />Project Number: 149273 <br />O <br />Report to, Sheila Richgels <br />12 <br /><sheila.richgels@CB1xom> 916-565-4327 <br />d <br />o <br />W <br />h <br />ba <br />Z E <br />x <br />Sampler's Signature:; <br />t: <br />J'�► — 01 <br />Q <br />a. <br />A <br />.. <br />Q. <br />o <br />z d <br />O <br />N <br />,� <br />REMARKS <br />Sample 2014 LAB Sample <br />WAS <br />L. LPE <br />250 nil <br />250 ad <br />500 LPF. <br />Container Types <br />I:D. Date Time I.D. Matrix. <br />ficl <br />NP <br />112504 <br />IiNO3 <br />IIN03 <br />atiolts <br />- MW -1 k1to.L�1 s'2 water <br />7. 3 <br />1 <br />I <br />I <br />1 SHO T <br />HO DING M <br />-2 MW -2 lyty\ water <br />7 3 <br />i <br />I <br />1 <br />1 r Oz <br />N O S <br />.3 MW -3A W°1 water <br />7 3 <br />1 <br />1 <br />1 <br />D <br />1 O CI BOMBAS COT <br />MWAA water <br />7 1 3 <br />1 <br />1 <br />1 <br />1 <br />MW -5 3t water <br />7 3 <br />1 <br />1 <br />1 <br />1 <br />- — <br />MW -6 I' water <br />7 3 <br />1 <br />1 <br />1 <br />1 GHK <br />�1 Field Blank water <br />2 2 <br />�$ Tri Blank water <br />2 2 <br />RELINQUISHED BY <br />RECEIVED BY <br />RELINQUISHED BY <br />RECEIVED BY <br />TURNAROUND <br />REPORT REQUIREMENTS <br />. <br />REQUIREMENTS <br />a4 hr _nanr _sa.y <br />X 1. Routine Report <br />11. Report (includes DUP, MS <br />Signn <br />Sig lire <br />Sign e (� <br />Sigi�yt re <br />h7 <br />Lam✓ <br />J <br />X <br />Sieedara (-ie-IS rw kid deye) <br />rro,aa. v.ra.l rr.nsas.ro asna, <br />MSD, as required, may be <br />charged as samples) <br />Printed Name <br />Prl (I Name ` <br />Pril d Neill <br />Printed Name,/ /K� <br />Pnul Weinhnrdt <br />/tb f <br />t�S S 1 <br />! L/ �(°�' <br />P—id. r•Ax PMWIn.ry R—ft, <br />nego.a.a ft,1—D.i.: <br />111. Dain Validation Report <br />(includes All Raw Date) <br />Firm <br />Firm <br />BCA <br />Firm <br />&- <br />Firm,%ZC / <br />jj✓✓ l <br />CBI <br />vq <br />X RWQCB <br />MDLs/P Ls/rRACHN <br />Datefrinte rlirtti ®O <br />DRlefl'inta i • / / <br />Datefrinte !,/6 •/ <br />Datefrinte ( -1 y 7 <br />RELINQUISIIED BY <br />RECEIVED BY <br />Special Instrucfimra/Comments: <br />Please report MRL's, PQL's <br />and <br />Trace. <br />BC Labs - Tina Green <br />4100 Atlas Court <br />Signr e <br />5iguntn <br />G <br />Nitritte-Nitrogen has a 48 -hr <br />hold <br />time. <br />Bakersfield, Cn 93308 <br />661-327-4911 /Fx: 327-1918 <br />Printed Nante <br />Printed Nnme�7 <br />Vr <br />Ship via UPS Acct 965376 <br />BC Lab Courier: <br />FirmFirm <br />0 C �% <br />((jj <br />Ross Dickey @ 661.201-4171 <br />Dntefrime -1 -f <br />Dale/rime ). L <br />RE: L"Wo eo— I -I (F -iK a;:t0 <br />n <br />O <br />w <br />7 <br />12. <br />0 <br />0 <br />0 <br />N <br />0 <br />O <br />W <br />11 <br />