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® CHAIN OF CUSTODY/LABORA Y ANALYSIS REQUEST FORM Page <br /> Shaw Environmental P.O.No: Direct Bill San Joaquin County <br /> 180 Promenade Circle Suite 320 Sacramento CA 95834 Lab: BC Labs Baicersrield <br /> Project Name: Foothill Landrill,San Joaquin County Analysis Re uested <br /> 1st Quarter Sampling 2011 .. <br /> ProjectNumber: 139867 (Lysimeters) <br /> Report to: Sheila Richgels,Shaw Environmental <br /> <sheila.richgels@shawgrp.com> 916-565-4327 <br /> CC Report to: Jody Rhoades,Shaw Environmental o r, <br /> <jody.rhoades@shawgrp.com> 916-565-43624-4 <br /> v <br /> ° W b <br /> Sampler's Signature: <br /> Oe8 ° <br /> U - REMARKS <br /> Sample 2011 LAB Sample .::.;: voA L P) 250ml 500H Container Types <br /> I.D. Date Time I.D. Matrix NP Nr IM03 Preservations <br /> LZ-01 water 14, 1 1 1 <br /> LZ-02 wat N'3 <br /> 1 1 1 <br /> LZ-03 6,x`--1 1 1 1 <br /> LZ-04 ater 6 1 1 1 <br /> i <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 48 hr �5 day 11. Report(includes DUP,MS <br /> ;Provide <br /> 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 /> FAX Preliminary Results 111.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 (MDLs/P Ls/TRACE# <br /> RELINQUISHED BY RECEIVED BY Special Instructions/Comments: Container Types Key: <br /> BC Labs-Tina Green 40 ml VOA: 1 <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 66172127-4911/Fx:327-1918 1 liter HDPE: 4 <br /> Ship via UPS Acct 965376 500 ml glass: 5 <br /> Firm Firm Lab Courien Ross Diekey 1 liter glass: 6 <br /> EDDs to<susan.waterman@shawgrp.com> 6" '1oV, "Z0 4171 2x6 s/s ring: 7 <br /> Date/Time Date/Time glass jar: 8 <br />