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CHAIN OF CUSTODY/LABORATORY ANALYSIS REQUEST FORM Page_of_ <br /> Shaw Environmental P.O.No: Direct Bill San Joaquin County <br /> 180 Promenade Circle Suite 320 Sacramento CA 95834 Lab: BC Labs Bakersfield <br /> Project Name: Foothill Landfill,San Joaquin County Analysis Re uested <br /> 1st Quarter Sampling 2011 <br /> Project Number: 139867 (Surface Water) o <br /> Report to: Sheila Richgels,Shaw Environmental03 <br /> <sheila.richgels@shawgrp.com> 916-565-4327 U '$ <br /> CC Report to: Jody Rhoades,Shaw Environmental o 00 eQ .. <br /> <jody.rhoades@shawgrp.com> 916-565-4362 w o `� z w <br /> - <br /> Sampler's Signature: yam H 0 <br /> U rn o <br /> I I IREMARKS <br /> Sample z 0/1 LAB Sample VOA Liter LPE 250m1 5ooml Container Types <br /> I.D. Date Time I.D. Matrix HCI NP NP HNO3 Preservations <br /> S-1 water 6 3 1 1 1 <br /> S-2 water 6 3 1 1 <br /> rin Fin • <br /> RELINQUISHED BY RECEIVED BY RELINQUISHED BY RECEIVED BY TURNAROUND REPORT REQUIREMENTS <br /> REQUIREMENTS X I. Routine Report <br /> Signature Signature Signature Signature 24 hr _4s hr 5 day II. Report(includes DUP,MS <br /> X Standard(-10-15 working days) MSD,as required,may be <br /> Printed Name Printed Name Printed Name Printed Name Provide Verbal Preliminary Results charged as samples) <br /> Provide FAX Preliminary Results III.Data Validation Report <br /> Firm Firm Firm Firm Requested Report Date: (includes All Raw Data) <br /> Shaw Environmental X RWQCB <br /> Date/Time Date/Time Date/Time Date/Time Ls/P Ls/TRACE#) <br /> RELINQUISHED BY RECEIVED BY Special Instructions/Comments: Container Types Key: <br /> BC Labs-Tina Green 40 ml VOA: I <br /> Signature Signature Please report MDLs,PQLs and Trace. 4100 Atlas Court 250 ml LPE: 2 <br /> Nitrate-Nitrogen has a 48-hr hold time. Bakersfield,Ca 93308 500 ml LPE: 3 <br /> Printed Name Printed Name 661-327-4911/Fx:327-1918 1 liter HDPE: 4 <br /> Ship via UPS Acct 965376 500 ml glass: 5 <br /> Firth Firm bab Geuriev Ross Diekey 1 liter glass: 6 <br /> EDDs to<susan.waterman@shawgrp.com> 661201 4171 2x6 s/s ring: 7 <br /> Date/Time Date/Time glassjar: 8 <br />