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CHAIN OF CUSTODY / LABORATORY ANALYSIS REQUEST FORM Page_of_ <br /> CBI Envh onmental&Infrastructure,Inc. P.O. Direct bill to San Joaquin County <br /> Lab: BC Labs Bakersfield <br /> 180 Promenade circle Suite 320 Sacramento Ca 95834 <br /> Project Name: Corral Hollow LF,San Joaquin County <br /> Anal sis Re uested <br /> Resample 9A,10A, 11A for BTEX Only <br /> 1st Qtr 2014 Quarterly Ground Water rA <br /> Project Number: 149266 <br /> Report to- Sheila Ricligels;CB&I00 <br /> <sheila.richgels®CBJ.com> 91 565-4327 (o <br /> -4 <br /> Sampler's Signature: REMARKS <br /> Semple 2014 LAS Sample Grr4j <br /> VOM <br /> Types <br /> p Preservations <br /> I.D. Date Time I.D. Matrix E Hct <br /> MW-9A2-� water 3 3 <br /> MW-10A <br /> -'Z water 3 3 <br /> MW-11ACZ 253 ��J water 3 3 <br /> Field Blank /'`I W. water 2 2 <br /> Trip Blank water 2 2 <br /> CHK YISTRI UTION <br /> SUB OUT <br /> RELIN )ISHED BY RECEIVED BY RELINQUISHED BY RECEIVED BY TURNAROUND REPORT REQUIREMENTS <br /> REQUIREMENTS X I. Routine Report <br /> Sign Sigt a SI t re 3ignatu 24 br 48 hr r,5 day lt. Report(includes DUP,MS <br /> rib G X standard(—io-15 working dnys) MSD,as required,may be <br /> Printed Name Prit Nem Prd Na Printed Namen ProvldeVerbalPreliminary Results charged as samples) <br /> Paul Weinhard( (�-�C' _ss-L✓1� C�Il/� Provide PAX Preliminary Results Ilt.DataValidationReport <br /> / Firm Requested Report Dote: (includes All Raw Date) <br /> Firm Finn Firm <br /> C13M 6C 1"I" �Cl-p }�j X RWQCB <br /> Daterrime — -j 6 Date/Timez -ly 1x06 Date/TimeZ 19x1 Date/Time -� r (MD Ls/P Ls/TRACBM) <br /> RE, BY RE[ BY Special Instructions/Comments: Container Types Key: <br /> EE <br /> Please report IYIDLs,PQLs,and Trnce. BC Labs-Tina Green 40 nil VOA: 1 <br /> SignatuSignature <br /> 4100 Atlas Court 250 ml LPE: 2 <br /> re <br /> Bakersfield,Ca 93308 500 mi LP}i: 3 <br /> 661-327-49111 Fx:327-1918 1 litor HDPE: 4 <br /> Printed Name Printed Name <br /> Ship An UPS Acct 965376 500 in]glass: 5 <br /> BC Lab Courier: 1 liter glass: 6 <br /> tDate/;Tbile <br /> Firm Ross Dickey Q 661-201-4171 2x6 s/s ring: 7 <br /> 1—� fess jar: 8 <br /> Date/Time <br />