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CHAIN OF CUSTODY/LABORATORY ANALYSIS REQUEST FORM Page_Of_ <br /> Shaw;Environmental,a CBI Company P.O. Direct bill to San Joaquin Count <br /> 180 Promenade Circle Suite 320 Sacr mento Ca 95834 ` �� 3 Z Lab: BC Labs,.Bakersfield <br /> Project Name:Corral Hollow LF,San Joaquin County Analysis Requested <br /> 1st Qtr 2014 Quarterly Ground Water <br /> Project Number: 149271 y <br /> Report to: Sheila Richgels,CB&I <br /> <sheila.richgels@CB1.com> 916-565-4327 v 1 <br /> rd y1 <br /> s <br /> t4. <br /> ani •G �1! ;d � ofi <br /> Sampler's Signature: n vi o Q *�•'' <br /> z Qsr v V .: `t REMARKS <br /> Sample 2014 LAB Sample 'k:`:' L LPE 250tnt VOAs 5001111 Cotitniner T es <br /> I.D. Date Time I.D. Mat�lx NP Nr rtes r1No3 Preservations <br /> MW-4 (-13-114 water 6 l 1 3 1 <br /> MW-5 — Z water 6 1 1 3 1 H <br /> SB-1 � — ,3 water 6 1 1 3 1 <br /> M.W-6 lZ --`a water 6 1 1 3 1 - <br /> MW-7 — water 6 1 1 3 1 <br /> MW-8 �.13 —Lo water 6 1 1 3 1 -' - <br /> MW-9A �Vlp water 6 1 1 3 1 +r. gcz <br /> MW-10A lU water 6 1 1 3 1 <br /> MW-1 IA water 6 1 1 3 1 <br /> Field Blank Ig v water 2 2 <br /> TriE Blank JAIA _0 water 2 2 <br /> RELINQUISHED BY RECEIVED BY RELINQUISHED BY RECEIVED BY TURNAROUND REPORT REQUIREMENTS <br /> i REQUIREMENTS X 1. Routine Report <br /> SgnatSia Sign <br /> Sture 24 hr 48 hr <br /> 5 day ii. Report(includes DUP,MS <br /> e ,, X Standard(-10.15 working days) <br /> MSD,as required,may be <br /> Tinted"Name PrintoName Printe ame rinsed Name Provide Verbal Proliminnry Results charged as samples) <br /> PaulWeinhardtx�IC C; ]L '6 Provide PAX Preliminary Results IILData Validation Report <br /> Firnl Firm �. Finn F( Y j Requested Report Data: (includes All Raw Data) <br /> CB&1 7 X RWQCB <br /> DatefTime r ;Q Date/Time r Date/Time G .6 Date/Time j-I 2 (MDLsIP L9/TRACE#) <br /> RELINQUISHED BY RECEIVED BY Spt:'clallnstruetion Comments: Container Types Key; <br /> Plelise report MDLs,PQLs,and Trace. BC Labs-Tina Green 40 ml VOA: 1 <br /> Si lure Signa 4100 Atlas Court 250 ml LPE: 2 <br /> i' ® 1VIt d1e iVltPttgln has A d$`Ut+Y{C��T IMI✓r Bakersfield,Ca 93308 500 ml LPE: 3 <br /> rintedNa to Printed Wame 661-3274911/Fx:327-1918 1 IiterliDPE: 4 <br /> S�E <br /> **J*Incl m,p-xylene&o-xylene In 8260 results. Ship via UPS Acct 965376 500 mi glass: 5 <br /> Firm Firm i BC Lab Courier: I liter glass: 6 <br /> / C h CLt-3 Ross Dickey n 661-201-4171 2x6 s/s ring: 7 <br /> Date(Time -/3�t'1 Dalelfime ��.0 glass jar: 8 , <br />