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CHAIN OF CUSTODY / LABORATORY ANALYSIS REQUEST FORM Page_of <br /> P.O.# Direct Bill to County <br /> Aft <br /> 180 Promenade Circle Suite 320 Sacramento CA 95834 <br /> Lab: BC Labs Bakersfield <br /> Analysis Re ueed <br /> Project Name: North County Landfill <br /> st <br /> San Joaquin County <br /> 3rd Qtr 2013 Lysimeters <br /> Project Number: 149270 <br /> Report to: Sheila Richgels <br /> <Sheila.Richgels@CBLcom> 00 U 79 <br /> Sampler's Signature: <br /> 0IRE O <br /> U REMARKS <br /> Container Types <br /> Sample 2013 LAB Sample VOAs L. LPE 250 LPE 250Preservations <br /> I.D. Date Time I.D. Matrix xcl NP HNO3 soa <br /> VZ-01 water 6 3 1 1 1 <br /> VZ-02A/B aa6 1 1 <br /> VZ-03A/B 1 1 1 <br /> VZ-04A/B 1 1 <br /> VZ-05A/B 1 1 <br /> VZ-06 3 1 1 1 <br /> VZ-07 3 1 1 1 <br /> 3 <br /> VZ-08 water 6 1 1 1 d <br /> a <br /> WED BY TURNAROUND REPORT REQUIREMENTS <br /> RELINQUISHED BY REC D BY RELINQUISHED BY RE, j <br /> REQUIREMENTS X I. Routine Report <br /> Signature Signature 24h, 4a hr s day IT. Report(includes DUP,MS <br /> Signature Signature may q,as required,uired, be <br /> X Standard(-10-15 working days) Y <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 Requested Report Date: (includes All Raw Data) <br /> Firm / Firm X RWQCB <br /> CBI Date/Time (MDLs/PQLs/TRACE#) <br /> Datefrime Date/Time Date/Time <br /> RELINQUISHED BY RECEIVED BY Special Instructions/Comments: = <br /> BC Labs-Tina Green 1, <br /> Signature Signature Report MDLs,PQLs,and Trace. 4100 Atlas Court <br /> Si <br /> gn Bakersfield,Ca 93308 <br /> 661-327-4911/Fx:327-1918 <br /> Printed Name Printed Name <br /> Ship via UPS Acct 965376 <br /> Courier: Ross 661-201-4171 II <br /> Firm Firm <br /> Date/Time Date/Time <br />