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O McCampbell Analytical, Inc. CHAIN OF CUSTODY RECORD <br /> WO 1534 Willow Pass Rd.(Pittsburg,Co.94565-1701 <br /> URN AROUND TIME: RUSH[a I DAY[a2 DAY ❑ 3 DAY [:15 DAY I <br /> www.mccompbell.com/ main@mccompbell.com' GcoTmcAer EDF[:k PDF❑ EDD❑ Write On(DW) EQutS [JID DAY/❑` <br /> Telephone: (877)252-9262/Fax: (925) 252-9269 <br /> Effluent Sample Requiring"Je Rag[a UST Clean Up Fund Project❑;Claim 9 <br /> Report To: Bill To: Anal sis Request <br /> Com an : Y;C. <br /> c t , 9ej e <br /> Tele: G E-mail: E! fi k _ t <br /> Project III! Pro'ectName: t 3 _ u <br /> Project Location: Purchase OrdeT9t <br /> Sampler Signature: o = x e o = r g <br /> SAMPLING MATRIX METHOD = L a` 5 " > a <br /> PRESERVED eS a o o e m <br /> Location/ y E r ^r O N N N G <br /> SAMPLE ID <br /> Field Paia c = <br /> Name Date Time - <br /> 3 e m ✓ � e o o � ''-•' h e <br /> U w G a = o r U Z s H a .m a aSit <br /> ae U W <br /> v <br /> T <br /> n <br /> D o <br /> Jl <br /> i <br /> —MAI clients MUST disclose any dangerous chemicals known to be present In thea submided samples In concenhaaons that may cause Immediate harm or serious future health endangerment as a result of brief,gloved,open all,sample <br /> handling by MAl Staff.Non•dhclosure Incurs an Immediate$250 surcharge and the client is subject to full legal Uablllty for harm suffered. Thank you for your understanding and for allowing us to work safely. <br /> —U metals ans requested for water m lesand fhe water typels nota edn Me chain of custody.then MAI n default to metal.by E2(&& <br /> Rel' hed By: Dst Time: R ry ICE/1' COMMENTS: <br /> J (f:3 OD CONDITION <br /> fL <br /> HEAD SPACE ABSENT <br /> elinquished By: Date: Time: Received By: DECHLORINATED IN LAB <br /> APPROPRIATE CONTAINERS_ <br /> PRESERVED IN L.AB <br /> Relinquished By: Date: Time: Received By: VOAS O&G METALS OTHER HAZARDOUS: <br /> PRESERVATION pHQ <br /> Page 15 of 18 <br />