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M <br /> O <br /> M <br /> a7 <br /> Or <br /> M <br /> o a. <br /> CHAIN OF CUSTODY/LABORATORY ANALYSIS REQUEST FORM Page—of— <br /> ,•y P.O.# San Joaquin County P.O.921356 <br /> S1jaWG 180 Promenade Circle,Suite 320 Sacramento,CA 95834 Lab: BC Lobs,Bakersfield s <br /> ProjectName:North County LF,Son Joaquin County Analysis Requested g <br /> 3rd Qtr 2012 Ground Water 5 <br /> Project Number: 139874 <br /> Report to:Shelia Rieligels(916-565-4327) -o E <br /> <Shei1a.R1chge1s@Shnwgrp.com> d .g <br /> cc Report: Jody Rhoades(916-565-4362) °o D0 _8 I: m <br /> <Jody.rhoades@showgrp.cam> w W 4 a <br /> A U <br /> Sampler's Signature: u p vi p REMARKS o, <br /> Sample 2012 LAB Sample von5 L. Lre 250 LPa 250 LVE <br /> Container Types w N <br /> 1,D. Date Time LD. Matrix tic! NP 1Mo2 112soa Preservations M <br /> G-1 { &51- water ::fi::: 3 1 l l a m <br /> _ water 6 3 <br /> N %S water 6 3 1 1 1 <br /> .- G_4 �°1i31 water 6 3 t I 1 0 Y <br /> 4) fi N <br /> IM Cr <br /> ®' G-6 "{ l \ZtZ- water 6 3 l 1 1 <br /> � ffin <br /> co Field Blank -7-31 MA water 2 2 ` ae <br /> kp Tri Blank 1 1 NI water 2 °� o <br /> rn <br /> r- RELINQUISHED BY RECEIVED BY RELINQUISHED BY RECEIVED BY TURNAROUND REPORT REQUIREMENTS <br /> r0 REQUIREMENTS X L Routine Report <br /> 0) <br /> Sig re Signpt'yla /, Sign re Sign uure _14h, _to tr _s a,r OZ <br /> Il. Report(includes OUP,MS v <br /> tp �%�Q ��!s, Q ti L X S an uuJ(-Io-IS w¢nana!¢Yc) MSD,as required,may be Y <br /> �t c y <br /> r� D Prt Nnm ) Print Name / Prinie Name �' Printed Namo ) Pr¢.;d¢V¢md Pr¢andn¢ry a¢,na¢ charged as samples) m <br /> Conhr�KOT' � s etc i ss re o� /LJ PraddePLCPr¢Nmin¢rylraeui„ III.DalnVnlldnlionReport 1 o C <br /> v Firm na¢aen¢a a¢P¢n ou¢: (includes All Raw Data) b o <br /> o Firm Firm G Firm t3C-�3 rx L�)j X RWQCB " >N <br /> n <br /> ` Shaw Environmental «'� <br /> a m <br /> 7 (MDLs/PQLsfRACEB) Q <br /> CDaleffimc �—L'/� Date/Time 2Q DoteDalefrlme -41 oc Special instructions/Comments:p RELINQUISHED BY <br /> RECEIVE <br /> V Report IVIDLs,PQLs,and Trace. BC Labs-Tina Orccn c c <br /> SI lure nolur 4100 Atlas Court <br /> `g� j4 J Bakersficid,Ca 93308 r <br /> E Printed Name P' to nme <br /> 661-3274911/Fs:327-1918 <br /> C H �� p G i�vt� _ Ship via UPS Acct 965376 e <br /> ul U Firm Firm y 5 <br /> , L f} EDDs to<susnn.tvnlermnn@shmvgrp.com> v <br /> O Dalerrime ID !T c <br /> LVJ-U n i lei I cJ,--'' _ <br />