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CHAIN OF CUSTODY/LABORATORY ANALYSIS REQUEST FORM Page,of_ 0 <br /> a <br /> R. <br /> P.O.P.O. Direct bill to San Joaquin County <br /> ® 180 Promenade Circle Suite 320 Sacramento Ca 95834 Lab: BC Labs,Bakersfield � b�, <br /> Project Name:Corral Hollow LF,San Joaquin County Analysis Re uested y < l <br /> 4th Qtr 2012 Ground WaterCL 3 Zia' <br /> Pro ect Nutnber: 139881 '< Q <br /> l a <br /> o Report to: Sheila Richgels,Shaw Environmental a W <br /> o <sheila.richgels@shawgrp.com> 916-565-4327 ob °� O. m <br /> a CC Report to: Jody Rhoades,Shaw Environmental o a o o <br /> y 9 o <Jody.rhoades@shawgrp.com> 916-565-4362 w o � o ro <br /> r <br /> 00 <br /> :2. <br /> o0 <br /> o0 <br /> a Sampler's Signature: _ &I &"A <br /> ° w <br /> V 6 REMARKS �. <br /> F `s Sample 2012 LAB Sample L.LPE 250 LPE 40nd VOAs Container T es <br /> m I.D. Date Time I.D. Matrix NP NP xcl <br /> FD w Preservations <br /> 3 <br /> r l MW-4 Lo-l5 b I water 5... 1 1 3 , co <br /> y o -Z MW-5 �'x-oI water 5 1 1 3 <br /> to 0 3 SB-i Wo water 5 1 1 3 <br /> S MW-6 }� water 5 1 1 3 -IUI i 00 <br /> a _ <br /> oa •�. c -`J MW-7 1yy water 5 1 1 3 v <br /> MW-8 `��® water 5 1 1 3 - . ... _. ... _ - 'v <br /> - to <br /> v! _g , ®® water 5 1 1 3 ": t° <br /> 6 s IME to <br /> � <br /> a -`b MW-10A water 5 1 1 3 +e , -' <br /> 0 <br /> �k A MW-11A � water 5 l 1 3 a BAS Of 3 w <br /> Field Blank N i.tt} water 2 2 <br /> 2 <br /> Tri Blank r-11 water <br /> v o s RELINQUISHED BY RECEIVED BY <br /> RELINQUISHED BY RECEIVED BY TURNAROUND REPORT REQUIREMENTS <br /> REQUIREMENTS X I. Routine Report <br /> w Vid <br /> Si ture Si ¢ture Signature 24 hr _48 hr _5 day I1. Report(includes DUP,MS <br /> X Standard(-10.15 working day.) MSD,as required,may be <br /> a <br /> o o ani i7rPrint�d/kName ) 'Printed Name/ Prjntod Name C Provide Verbal Preliminary Results charged as samples) <br /> (�� It/ ,E a�' PmvldaFAXPmiimfneryRasult. M.Data Validation Report <br /> mi Firm Firm f Fi Firm ��� Raqua.tedRapennata: (includes All Raw Data) <br /> N o 31 FirmShaEnvironmental C� C . X RWQCB <br /> p g Date/Time DLs/PQLs/TRACEN <br /> o a DatelTime tv-i 2- Date/Time _g_ 0 Date/Tir _ - 2_ <br /> 3 RELINQUISHED BY RECEIVED BY Special Instructions/Comments: <br /> n BC Labs-Tina Green <br /> 0 04100 Atlas Court <br /> s Signature Si nature Please report MDLs,PQLs,and Trace. <br /> Nitrate Nitrogen has a 48-hr hold time. Bakersfield,Ca 93308 <br /> a 3 Printed Name Printed Name^ 661-327-4911/Fx:327-1918 <br /> Incl m,p-xylene&o-xylene in 8260 results. Ship via UPS Acct 965376 <br /> 5'gFirm Fimt <br /> BC Courier: <br /> EDDsto<susan.waterrmn@shawgrp.com> Ross Dickey a 661-201-4171 <br /> Date/Time 10-15'15 .' Daterrime .,L - I <br /> 0 <br /> d <br /> '0 P <br /> N <br /> W <br /> O_ <br /> co <br /> co <br />