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M MM min= <br />CHAIN OF CUSTODY LABORATORY ANALYSIS RE QUEST FORM Page -�- of <br />i <br />P O Direct bill tblan;iToaquizi C6urity <br />t .- ncoze 1 �7 1 l <- Loh RC Tabs. Balser stield <br />'d ll - <br />ProjectName: Coral <br />AVV A l Vll1Gl14ua; . I —, ---. <br />Hollow LF, San Joaquin County <br />) - <br />---- - <br />Analysis <br />Requested <br />9F; <br />3rd Qtr 2013Gro <br />Li nd Water Sampling <br />Project Number: <br />149271 <br />Report to: Sheill <br />Aichgels, CB&I <br /><sheilaxieligels <br />&BI.com> 916-565-4327 <br />v , <br />v <br />01 <br />cu .: <br />Sampler's Signattt <br />I: <br />a, <br />REMARKS <br />E. <br />Sample <br />2013 LAB Sample <br />L. LPE 250 LPE 40" VOAs <br />rrom LPE <br />500m1 :_, <br />Container Types <br />NP rrn HCl <br />NP <br />IIN03 <br />Preservations <br />LD. <br />Date Time LD. Matrix <br />MW -4 <br />-1-IB-3 <br />147- <br />water <br />5 <br />1 1 3 <br />_ 1.5 <br />°-l� <br />water6 <br />1 1 3 <br />XX <br />1. <br />—3 SB -1 <br />Zt�1 <br />water <br />5 <br />1 1 3 <br />MW -6 <br />I <br />' l3 <br />water <br />5 <br />I 1 3 <br />- r� ! Qo <br />p <br />water <br />5 <br />1 1 3 <br />- <br />^(p MW -8--L <br />10i -S'— <br />water <br />5 <br />1 1 3 <br />MW -9A <br />��' <br />q <br />water <br />5 <br />1 1 3 <br />MW-l0A <br />11 <br />water <br />5 <br />1 1 3 <br />STRl UTI <br />N <br />MW-11A <br />water j <br />5 <br />1 1 3 <br />`.O Field Blank <br />to Ii} <br />water <br />2 <br />sUs pU <br />•_' I Trip Blank <br />%--) n <br />water <br />2- <br />1 2 <br />RELINQUISHED BY <br />RECEIVED BY <br />RELINQUISHED BY RECEIVED BY TURNAROUND REPORT REQUIREMENTS <br />REQUIREMENTS X I. Routine Report <br />Sign here 5ignahl 24 hr 48 hr _5 day II. Report (includes DUP, MS <br />Si t lure <br />tMed <br />X Standard (-10-15 working days) MSD, as required, may be <br />P nted NamPrinted Name Provide verbal Preliminary Results charged as samples) <br />�'6.5� M. Data Validation Report <br />me <br />I <br />notedN e <br />D <br />, <br />2.. ( j/g�( NA Provide FAX Preliminary Results <br />Firm <br />Firm <br />Firm ( Firm Requested Report Date: (includes All Raw Data) <br />5C -'5c :5 X RWQCB <br />CB&I <br />Daterrime — e' <br />Date/Time — <br />l�� <br />Date/Time _ Date1Time - Qj-( I ct WLs/PQLs/TRACE#) <br />RELINQUISHED <br />BY <br />RECEIVE Y <br />Special Instructions/ omrrients: <br />BC Labs - Tina Green <br />Please report MDLs, PQLs, and Trace. 4100 Atlas Court <br />Signator <br />i <br />Signature / / <br />j <br />K <br />iVltl me Nitrogen hns:ii 48 hrfiold time:: Bakersfield, Ca 93308 <br />661-327-4911 / Fx: 327-1918 <br />**** Incl m,p-xylene & o -xylene in 8260 results. Ship via UPS Acct 965376 <br />Print d tirrle <br />�� <br />Printed Name <br />� <br />!V <br />BC Courier: <br />Ross Dickey @661-201-4171 <br />Finn <br />Fin" (� <br />rnatA/Time'l 9.,1 <br />l a <br />Daterrime <br />