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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 uested <br /> 3rd Quarter Sampling 2013 'I <br /> ro <br /> Project Number: 149269 (Lysimeters) <br /> Report to: Sheila Richgels,Shaw Environmental i <br /> <sheila.rich gels@CB&I.com> 916-565-4327 N ;, d <br /> b tw +� N <br /> U <br /> a o d �, <br /> v <br /> 9 m W <br /> Sampler's Signature: p REMARKS <br /> V <br /> Sample 2013 LAB Sample VOA L LPs 3 t 50ong Container Types <br /> I.D. Date Time I.D. Matrix HC1 NP Preservations <br /> LZ-01 water 6 3 <br /> LZ-02 water 6 1 1. <br /> LZ-03 water 1Aon1 <br /> LZ-04 water 6 3 1 1 <br /> j <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 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 M.Data Validation Report <br /> Firm Firm Firm Firm Requested Report Date: (includes All Raw Data) <br /> CBI X RWQCB <br /> Date/Time Date/Time Date/Time Date/Time Ls/PQLsnRACE#) <br /> RELINQUISHED BY RECEIVED BY Special Instructions/Comments: 1 <br /> BC Labs-Tina Green <br /> Signature Signature Please report MDLs,PQLs and Trace. 4100 Atlas Court ! <br /> Nitrate-Nittogen has a48Ae hold time. Bakersfield,Ca 93308 <br /> Printed Name Printed Name 661-327-4911/Fx:327-1918 <br /> Ship via UPS Acct 965376 <br /> Firm Firm Courier: Ross 661-201-4171 <br /> EDDs to<susan.waterman@shawgrp.com> <br /> Date/Time Date/Time <br />