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mmmm <br /> CHAIN OF CUSTODY LABORATORY ANALYSIS REQUEST FORM Page_of <br /> 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 nested <br /> Surface Water Sampling 2013 d <br /> Project Number: 149269 (Surface Water) N ,� <br /> Report to: Sheila Richgels,CB&I Q1 to <br /> <sheila.richgels@CBI.com> 916-565-4327 ' v d <br /> op °O n xl <br /> U a o' Z W <br /> o Z, <br /> r <br /> Sampler's Signature: 0 44 C�Fes ; o <br /> F V REMARKS <br /> Sample 2013 LAB Sample von Liter LPE 250ml 500m] Container Types <br /> I.D. Date Time LD. Matrix xct NP NP HNO3 Preservations <br /> S-1 water 6 3 1 1 1 <br /> S-2 water 6 3 1 1 <br /> IN <br /> NN 1 P1 <br /> AA it <br /> RELINQUISHED BY 1 CEIVED BY RELINQUISHED BY IVE Y TURNAROUND REPORT REQUIREMENTS i <br /> REQUIREMENTS X I. Routine Report <br /> Signature Signature Signature Signature 24 hr 48 hr _5 day 11. 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 nate: (includes All Raw Data) <br /> X RWQCB <br /> CBI <br /> Date/Time Date/Time Date/Time Date/Time (MDLs/PQLs/TRACE# <br /> RELINQUISHED BY RECEIVED BY Special Instructions/Comments: <br /> BC Labs-Tina Green <br /> Signature Signature Please report MDLs,PQLs and Trace. 4100 Atlas Court ' <br /> Nitrate-Nitrogen has a.48-hr hold tient.. Bakersfield,Ca 93308 <br /> Printed Name Printed Name 661-327-4911/Fx:327-1918 <br /> Ship via UPS Acct 965376 <br /> Flan Firm Courier: Ross 661-201-4171 <br /> EDDs to<susan.watcrman@shawgrp.com> <br /> Date/Time Date/Time <br />