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CHAIN OF CUSTODY t 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,Baitersl;eid <br /> ProjectName: Foothill Landfill,San Joaquin Count), Analysis Re uested <br /> 3rd Quarter Sampling 201.3 <br /> ProjectNumber: 149269(Ground Water) <br /> Report to: Sheila Richgels,CBM v PQ <br /> <sheiln.riehgels s CBi.com> 91.6-565-4327 N = hz <br /> U Q `��, d <br /> o <br /> n ;2,; z i <br /> Sampler's Si A `I p <br /> P Signature: ;Sam ' nature: Q <br /> E- U REMARKS <br /> ample 2013 LAB Sample >i>': v0A LiterLPG 7snrul loom( Container Types <br /> I.D. Date Time I.D. Matrix tict NP NP UN03 _ __Preservations <br /> MW-IA ,Z,>j �`1Z' water 6„ 3 1 1 1 5�0 T 110 - IMG+ TI.VIE <br /> —,Z Field Blank 7A <br /> water 2 2 (%r*e NIO2 C 13 OP SS <br /> �j <br /> Trip Blank water 2 2 [10 CIz Bt)D MEAS COT <br /> CISTI IDIFiGN <br /> RELiNQUISiIED BY RECEIVED BY RELINQUISHED BY IVCD BY TURNAROUND REi'ORT REQUIREMENTS <br /> REQUIREMENTS X 1, Routine Report <br /> Sig re Sig re 5ignpC a SI na v bi hr d6lir _9 day 11. Report(includes DUP,MS <br /> r <br /> rx 9 r/Jf0_ j 5 C bP-C AJ X 5lnndnrd(-1(615 working days) MSD,as required,may be <br /> 46�— <br /> Prin Nurne Printfd Namp I Prigtpd Name v Printed Name Provide Verbal Preliminary Remhe churged as samples) <br /> L Provide FAX Preliminary Results M.Dula Validation Report <br /> Firm Firm Firm nC Firm f .S� Requested Raport Dale: (includes All Raw Data) <br /> CBI ,� r X RWinC13 <br /> Duterrim , I- Daterrime el)&- ) Dulcrrime,'Tr (,t3 3b Date/Time (MDLs(PQLsrrRACE#) <br /> RELINQUISHED BY RECEIVED BY Special instructions/Commeno: <br /> BC Labs-Tina Green <br /> Signalure Signature y Please report MDLs,I'QL9 nud Trace. 4100 Atlns Court <br /> Q Nitrate-Nltrugen Ims n 48-hr hold time. Bakersfield,Ca 93308 <br /> Printed Name Printed Nwne 661-327-49111 Fs:327-1918 <br /> v rB/�(V.CE f jlf Ship via UPS Acet 965376 <br /> Firm pian ,/� !� Courier. Ross 661-201-4)71 <br /> t C L�'1�. 13 ' 0 16 afn fi EDDs to<susarimnterm an«shmrgrpxom> <br /> Datelfime8.'_ �� Dalelrime l r>2 <br />