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CHAIN OF CUSTODY/LABORATORY ANALYSIS REQUEST FORM Page_of_ w <br /> aP.O. Direct bill to San Joaquin County c <br /> tC� ® 180 Promenade Circle Suite 320 Sacramento,Ca 95834 l C(2h Lab: BC Labs,Bakersfield -h <br /> a ct Project Name:Corral Hollow LF,San Joaquin County Analysis Re uested H <br /> 2nd Qtr 2012 Ground Water p <br /> y <br /> Project Number: 139881 <br /> Report to: Sheila Richgels,Shaw Environmental ' w <br /> <sheila.rlchgels@shawgrp.com> 916-565-4327 2 CL -� A <br /> °b CC Report to: Jody Rhoades,Shaw Environmental o p13a <br /> 0 <br /> o �°^ <jody.rhoades@shawgrp.com> 916-565-4362 w L) bo � .� p ro <br /> D o � <br /> lwse <br /> to ro f y� Ry N S <br /> y <br /> L z z <br /> C)t Sampler's Signature: o o <br /> t' REMARKS M Cn �y <br /> P Sample 2012 LAB Sample L.LPE 250 LPE 40ad WAS Container TypesT 5 <br /> C I.D. Date Time I.D. Matrix <br /> NP NP HCl Preservations o <br /> MW-4 -ZI 16310water:. <br /> 5,... 1 1 3 <br /> to <br /> CL <br /> ° - 2 MW-5 water 5 1 1 3 I' �i13U 10 0 <br /> > o N <br /> m$ SB-1 ®6® water 5 1 1 3 c <br /> g MW-6 l® water 5 1 1 3 3 T <br /> MW-7 water 5 1 1 3 <br /> s. r, MW-8 Bvi water 5 1 1 3 m <br /> t Field Blank F} water 2 2 Cr+s NO CD <br /> 0 <br /> Trip Blank 11 water 2 DOof, Ro <br /> - C of <br /> -n° °meg ea <br /> rn 3 RELINQUISHED BY RECEIVED BY RELINQUISHED BY RECEIVED BY TURNAROUND REPORT REQUIREMENTS <br /> w REQUIREMENTS X I. Routine Report <br /> $ Signatu Si a Sl re Si a 24 hr _49 hr _5 day IL Report(includes DUP,MS <br /> y rf[ X standard(-tats working days) MSD,as required,may be <br /> Printed a Printed e P' d Printed Name ) Provide Verbal PretiminaryResults charged as samples) <br /> 6j� Provide FAX Prell naryResuha III.Data Validation Report <br /> FirmFirm G Firm Film f quested Report Date: (includes All Raw Data) <br /> Q Shaw Environmental L f� X RWQCB <br /> m x Date(rime ,•2.1-1'L ( Date/Time Z � <br /> at .� L/ Date/Tirne - ,7 (MDLs/PQLsr ACE#) <br /> '�' RELINQUISHED BY RECEIVED BY ecial Instructions/Commen : Container Types Key: <br /> 3 o- BC Labs-Tina Green 40 ml VOA 1 <br /> Si tore S' lure ase eport MDLs,PQLs,and Trace. 4100 Atlas Court 250 ml LPE: 2 <br /> 4 A-Y• � has a 48-hr hold time. Bakersfield,Ca 93308 500 W LPE: 3 <br /> Printed Name ) Printed N (� 661-327-4911/Fx:327-1918 1 liter HDPE: 4 <br /> X306R•/t/ ,Q, UU * **Incl m,p-xylene&o-xylene in 8260 results. Ship via UPS Acct 965376 500 nil glass: 5 <br /> o ' Firm Firm BC Courier. l liter glass: 6 <br /> 4/1-b EDDs to<susan.waterman@shawgip.com> Ross Dickey @ 661-201-4171 2x6 s/s ring: 7 <br /> JEf <br /> ate/rime _ _.y <br /> Date/Time _2 a Iz glass jar 8 <br /> a2 r 1w1A G n9 FA )Iv— <br /> to 1vwt0 <br /> to <br /> W <br /> O <br /> A <br /> N <br />