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i <br /> CHAIN OF CUSTODY/LABORAT RY ANALYSIS REQUEST FORM Page—04D <br /> — <br /> P.O.No: Direct Bill San Joaquin County <br /> Shaw Environmental <br /> 180 Promenade Circle Suite 320 Sacramento CA 95834 - 2 Lab: BC Labs,Bakersfield <br /> ProjectNatne: Foothill Landfill,San Joaquin County Analysis Re uested <br /> Ist Quarter Sampling 2011 <br /> Project Number: 139867 (Ground Water) <br /> Report to: Sheila Richgels,Shaw Environmental v pq <br /> <sheila.richgels®shawgrp.com> 916-565-4327 � <br /> CC Report to: Jody Rhoades,Shaw Environmental U d00 <br /> �� 0 � o' •o <br /> <Jody.rhoades@shawgrp.com> 916-565-4362 c W v <br /> tu <br /> Sampler's Signature: �, q ti b <br /> a <br /> O c REMARKS <br /> Sample 2011 LAB Sam le 1! ^` von Liter LPE 250rnt 500mt ContainerT es <br /> p <br /> I.D. Date Titne LD. Matrix <:'•`;i HCi HNo3 Preservations <br /> water <br /> MW-2R 8�`1� ' --t water 6 3 1 1 1 C K B ISTi�if3UTiON <br /> MW-3 $-1ta.t1 "� 2 water 6 3 1 i 1 _J $UB-OUT C <br /> MW-4 $.9all ® °3 water 6 3 1 1 1 <br /> MW-5 8,10.11 water 6 1 3 1 1 1 <br /> LW-1 .1v-Il 11 water 6 3 1 1 1 nA ' G TIME <br /> 5+"CNC. O OPSSField Blank 8�•t� W tD water '2 2Tri Blank 8.9-11 Nits} s water 2 2 I BOD MBAS COT. <br /> RELINQUISHED BY RECEIVED BY RELINQUISHED BY RECEIVED BY TURNAROUND REPORT REQUIREMENTS <br /> REQUIREMENTS X I. Routine Report <br /> MS <br /> Sign re 5i gatu atur Signature 24 hr _^Ag hr _5day R. Report(includes,may <br /> be <br /> X Standard t-10-15 working days) MSD,a5 required,may be <br /> P d Nam Prints ams inted ame Printed Name 1711�°� Provide Verbal PrdimineryAeeults charged as samples) <br /> w O Provide FAX Preaminery Results AI.Data Validation Report <br /> Firm 4� Firm ,(� Firm Requested Report nate: (includes A11 Raw Data) <br /> Firm S� 1� X RWQCB <br /> Shaw Environmental ��JJ ►.! DLs/P Ls/TRACE# <br /> Dale/TimeQ—,o•1 eQ Dat m s Datelfime$- C;-. ) <br /> RELINQUISHED BY RECEIVED BY Special Instructions/Comments: Container Types Key: <br /> BC Labs-Tina Green 40 ml VOA; 1 <br /> Si nature PleRse report MDLs,PQLs and Trace. 4100 Atlas Court 250 nil LPE: 2 <br /> Signature g Bakersfield,Ca 93308 500 ml LPE: 3 <br /> Nitrate-Nitrogen has a 48-hr hold time. <br /> 661-327.4911/Fx:327-1918 1 liter HDPE: 4 <br /> Printed Name Printed Name <br /> Ship via UPS Acct 965376 500 nil glass; 5 <br /> 1 liter glass. 6 <br /> Firm Firm <br /> EDDs to<susan.tvnterman®shawgrp.com> "'"r 'w�141T* 2x6 s/s ring: 7 <br /> glassjar: 8 <br /> DatelTime Date/Time <br />