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M ® M ® M M = M ® M M M ® M M M M <br />CHAIN OF <br />CUSTODY / LABORATORY ANALYSIS REQUEST FORM <br />Page la <br />P.O.. Direet;bill to San Joaquin County <br />° <br />180 Promenade Circle Suite 320 <br />Sacramento, Ca 95834 <br />��i�f% <br />Lab: <br />BC Labs, Bakersfield <br />Project Name: Co <br />ral hollow LF, San Joaquin County <br />Analysis Re uested <br />b <br />3rd Qtr 2013Grojud <br />Water Sampling <br />Project Number: <br />1'49271 <br />r <br />Report to: Shelb <br />Richgels, CB&I <br />_ <br />a <br /><sheila.richgels <br />61.com> 916-565-4327 <br />ro <br />v <br />`.C. <br />w....«i <br />z <br />z v <br />C <br />a 1 <br />Sampler's Signati <br />E <br />` v <br />w <br />f <br />REMARKS <br />Sample <br />2013 LAB <br />Sample <br />L. LPE <br />250 LPE <br />40in1 VOAs <br />From LPE 500m1_ <br />Container Types <br />xP <br />NP <br />act <br />NP io3 lx <br />Preservations <br />LD. I <br />Date Time I.D. Matrix <br />^ MW -4 <br />-1 -1 B- L31 kZNZ <br />water <br />5 1 <br />1 <br />3 <br />- Z MW -5 <br />1 `1b <br />water <br />6 1 <br />1 <br />3 <br />XX 1 <br />-3 SB -1Z,'; <br />water <br />5 1 <br />1 <br />3 <br />FI4 ... <br />MW -6 <br />,13 <br />water <br />5 1 <br />1 <br />3 <br />9r.tq..�Q <br />40 <br />OP <br />- _7 <br />I <br />I 331A <br />water <br />5 1 <br />1 <br />3 <br />00 <br />^ {y MW -8 <br />,tT5' <br />water <br />5 1 <br />1 <br />3 <br />MW -9A <br />water <br />5 1 <br />1 <br />3 <br />MW- l0A <br />it <br />water <br />5 1 <br />1 <br />3 <br />1 UK <br />STRI UTI <br />N <br />MW -11A <br />water <br />5 1 <br />1 <br />3 <br />L.4 Field Blank <br />(.'I)!) <br />water <br />2 <br />SUET pUT <br />^� Tri Blanic <br />N <br />water <br />Z <br />2 <br />__ - <br />RELINQUISHED B <br />BY <br />RELINQUISHED BY <br />RECEIVED BY <br />TURNAROUND <br />REPORT REQUIREMENTS <br />IRE,CEIVED <br />REQUIREMENTS <br />X I. Routine Report <br />24 hr 4s Iv 5 doy <br />Z Report (includes DUP, MS <br />Sin lure <br />Sign ave <br />Signati <br />JP,) <br />XSmedord(-,0-15—kirad,y,) <br />MSD, as required, may be <br />Provide Vrbal Preliminary Result, <br />charged as samples) <br />ID. Data Validation Report <br />Name <br />anted Ne c <br />nted Name <br />Printed Name <br />�-5c 313 -Ref ML. <br />� <br />or rZ <br />PmvideFAXPre11mineryR-11, <br />R,,eosled RePnn Dme: <br />(includes All Raw Data) <br />X RWQCB <br />Finn <br />CB&I <br />Finn <br />Finn <br />Firm <br />$C t..�3 <br />(MDLs/P Ls/TRACEII ) <br />Date/Time — ®1 <br />Date/Time - H <br />Datelrime <br />Date/Time - 8-J3 <br />RELINQUISHED <br />BY <br />! <br />RECEIVEDAY <br />Special Instructlons/Comrdents: <br />BC Labs -Tina Green <br />Please report MDLs, PQLs, and Trnee. <br />4100 Atlas Court <br />Signator <br />Signature <br />— <br />Nitrate Nitrogen hfis a 484 <br />r hold time. <br />Bakersfield, Ca 93308 <br />661-327-4911 / Px: 327-1918 <br />Print d lime <br />ICtiD <br />Printed Name <br />yK� <br />**** Incl m,p-xylene & <br />o -xylene in 8260 <br />results. <br />Ship via UPS Acct 965376 <br />BC Courier: <br />Firm <br />Firm <br />3 t, k <br />G( !' <br />Ross Dickey Q 661-201-4171 <br />Date/Time z <br />! ` <br />Daterrime - IS <br />