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CHAIN OF CUSTODY /LABORATORY ANALYSIS REQUEST FORM Page____of_ <br /> P.O.# Direct Bill to County <br /> ell 180 Promenade Circle Suite 320 Sacramento CA 95834 Lab: BC Labs,Bakersfield i <br /> Analysis Re uested <br /> Project Name:North County Landfill <br /> San Joaquin County <br /> 3rd Qtr 2013 Surface Water V <br /> Project Number: 149270 <br /> Report to: Sheila Richgels(916-565-4327) <br /> <Sheila.Richgels@CBI.com> U 00 <br /> o on <br /> Sampler's Signature: p r" �pMAR{S <br /> Sample 2013 LAB Sample VOAs LLPE 250 LPE 2so Container Types <br /> I.D. Date Time I.D. Matrix HCl NP xrro3 soa Preservations <br /> S-1 water 6 3 1 1 <br /> S-2 water 6 3 1 1 rA <br /> 04 <br /> s <br /> RELINQUISHED$Y' RECEIVED BY RELINQUISHED BY RECEIVED BY QINPOR �QENTSREUEM TS XIRouine Report <br /> Signature r 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 <br /> Printed Name Printed Name Provide Verbal Preliminary Results charged as samples) <br /> Provide FAX Preliminary Results III.Data Validation Report <br /> Firm Firm Firm Requested Report Dace: (includes All Raw Data) <br /> Firm X RWQCB <br /> CBI <br /> Date/Time Date/Time <br /> Date/Time Date/Time <br /> (MDLs/PQLs1TRACE# <br /> RELINQUISHED BY RECEIVED BY Special Instructions/Comments: <br /> BC Labs-Tina Green <br /> Report MDLs,PQLs,and Trace. 4100 Atlas Court <br /> Signature Signature P 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 <br /> Firm Finn <br /> Date/Time Date/Time <br />