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CHAIN OF C.USTODY LABORATORY ANALYSIS REQUEST FORM Page of <br /> CBI Environmental&Infrastructure,Inc. <br /> P.O.# Direct Bill to County <br /> 180.Promenade Circle Suite 320 Sacramento,CA 95834 I�I-(�� a(� <br /> Project Name;North County:LF;.San Joaquin County Lab: BCLibs,I3alcersticld <br /> W.Qtr 2014: Analysis Re uested <br /> Annual Ground Water.Sampling <br /> Project Number: 149270 pa tG <br /> Report to:Sheila Richgels(916-565-4327)'*,.- <br /> <Sheila.Ricllgels@CBl.com> o N 00 <br /> d•00m <br /> U d <br /> a, n z L <br /> 0 W 3 a <br /> b.. 0 <br /> o y <br /> Sampler's Signature; H ;Ji <br /> W <br /> Gq ti <br /> V <br /> j 0 p =' <br /> Sample 2014 U U _` REMARKS <br /> I LAB Sample VOAs 250 LPE L LPE 250 LPE 250 LPE 500 LPE <br /> 1HCI NP NP HNO3 H250<t I1NO3 Container Types <br /> Preservations <br /> .D. Date Time LD. Matrix -es.. <br /> G-1 ,•�. ''I� —� water .....8,., 3 1 ] 1 ] ] <br /> G-2A water 8 3 1 1 <br /> G-3D 1 ] ] <br /> water 8 3 1 1 1 ] ] <br /> G-4 water 8 3 1• i 1 1 1 <br /> ' A G-5A j. 9 - water 8 3 1 ] 1 1 ] <br /> 11✓ Field Blank •7.q —Cp water 2 2 <br /> Trip Blank to ®^7 water 2 2 <br /> RELINQUISHED BY RECEIVED BY RELINQUISHED BY RECEIVED BY TURNAROUND <br /> RCPORTREQUIREMENTS <br /> Sign re REQUIREMENTS X 1. Routinc Report <br /> Si ue Sig� e Signaure 2n hr as hr sda <br /> C" y 11. Report(includes DUP,MS <br /> .LG% 11�c X Slandard(-10-15 working days) MSD,as requlrcd,may be <br /> Printed Name I'dt�d Nam Pru d Nnme <br /> ,, / � PI'il1lC(I Na171C Provide Verbnl Preliminary Results Charged as samples) <br /> PaullVcinhnrdt � LG' v DSS �r 'Lay ! <br /> WA <br /> Punt Plan Pine PianProvlda PAX Preliminary Results III.Data Validation Report <br /> l✓ C1 <br /> CCIN /YJ Re uosled Report Date: (includes All Ravv Data) <br /> Dateiilte j•zq-j ' 30 Dale/Time X RWQCD <br /> `Z 2-� DalerT'ime(• 9,j - /S� Date/Dime _ <br /> RELINQUISHED BY RECEIVED BY Special Instructions/Comments: (HDLs/PQLsCfRACLl1) <br /> Report AIDLs,PQLs,and Trace. BC Labs-Tina Green <br /> Sin ure Signature Nitrate-Nitrogen has it 48-lir(told. <br /> 41.00 Atlas Court <br /> Printed NamePrinted Nanta Bakersfield,Cn 93308 <br /> 661-327-4911 /Fx:327-1918 <br /> Fit- Pin» Courier; Ross 661-201-4171 <br /> ci- Ship via UPS Acct 965376 <br /> Delellirate _) _ 33 Dnle/1into <br /> k10 -- i-?A -JH ;!900 <br />