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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 County <br /> ° 180 Promenade Circle Suite 320 Sacramento,Ca 95834 Lab: BC Labs,Bakersfield <br /> Project Name: Corral Hollow LF,San Joaquin County Anal sis Requested <br /> 2014 Surface Water ^ <br /> Project Number: 149271 <br /> e <br /> Report to: Sheila Richgels,CB&I v , <br /> <sheila.richgels@CB1.com> 916-565-4327 <br /> a �? <br /> O U ctl <br /> n <br /> Z <br /> O .o � <br /> O <br /> Sampler's Signature: U �o U; o o c <br /> U U U REMARKS <br /> Sample 2014 LAB Sample 40m1 VOAs L LPE 250 LPE 500 LP Container Types <br /> I.D. Date Time I.D. Matrix HCl NP NP 3 Preservations <br /> SW-1 water 6... 3 1 1 1 <br /> SW-2 water 6 3 'f 1 <br /> RELINQUISHED BY RECEIVED BY RELINQUISHED BY RECEIVED BY TURNAROUND REPORT REQUIREMENTS <br /> REQUIREMENTS X I. Routine Report <br /> i <br /> Signature Signature Signature Signature 24 hr _48 hr _s day 11. Report(includes DUP,MS <br /> X Standard(-40-15 working days) - MSD,as required,may be' <br /> Printed Name Printed Name Printed Name Printed Name Provide verbal Preliminary Results charged as samples) <br /> Paul Weinhardt Provide FAX Preliminary Results 111.Data Validation Report <br /> Firm Firm Firm Firm Requested Report Date: (includes All Raw Data) <br /> CB&I X RWQCB <br /> Date/Time Date/Time Date/Time Datefrime MDLs/PQLs/T'RACE#) <br /> RELINQUISHED BY RECEIVED BY Special Instructions/Comments: Container Types Key: - <br /> BC Labs-Tina Green 40 ml VOA: i <br /> Signature Signature Please report MDLs,PQLs,and Trace. 4100 Atlas Court 250 ml LPE: 2 <br /> Nitrate Nitrogen has a 48-hr hold time. Bakersfield,Ca 93308 500 ml LPE: 3 <br /> Printed Name Printed Name 661-327-4911/Fx:327-1918 1 liter HDPE: 4 <br /> ****Incl m,p-xylene&o-xylene in 8260 results. Ship via UPS Acct 965376 500 ml glass: 5 <br /> Firm Firm BC Courier: I liter glass: 6 i <br /> Ross Dickey @ 661-201-4171 2x6 s/s ring: 7 <br /> Date/Time Date/Time glass jar: 8 <br />