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General COC MAT Work Order# \ 3\CPn <br /> ® McCAMPBELL ANALYTICAL, INC. ChIAIN OF CUSTODY RECORD <br /> O1534 Willow Pass Rd.Pittsburg,Co.94565.1701 Tim Armand Tirms:I Day Rush 12 Day R.shl 3 Day Rush I STD Quote# <br /> WO Telephone:(877)252-9262/Fax:(925)252-9269 JFlag/MDL ESL Cleanup Approved Bottle Order# <br /> a�aw.ntccampbell.com main(t�.mecamnl7cll.com Delivery Formal: PDF GeoTmcker EDF EDD Write On(DW) EQuIS <br /> at <br /> ReportTo. �� Bill To: Analysis Requested <br /> Company: a - a S'4. �.. <br /> Email: �a 3 rn r.« . a S e E�1 z E <br /> Alt Email: Tele: <br /> a > <br /> Project Nam-: 1 ,4{,. Project#: <br /> at sa <br /> g o < > _ ` <br /> Project Location: p Cit- PO# _ — o J J r _ <br /> —> : _ <br /> Sampler Signature <br /> SAMPLE ID Sampling s y e _ `� _ e _ e $ m — m <br /> a Matrix Preservative A < 2 U C U _ r: ;e a ,^„ (+„ w _ <br /> Location/Field Point Date Time u r ;. -) „ _ = _ = a e sl i i i a < - <br /> MAI clientsMUST disclose any dangerous chemicals known to be present in their submitted samples in ameeabatams that may cmnc imnxdime harm ur serious future health emlangemtent ase result of lane[gloved,open air,sample handling by MAI slaf. <br /> Nae-disclosure ineum an immediate$250 surcharge and the client is mhjeei m Poll legal liability for barn sulrac 1.Tmnk you fm your nudcrstanding and for allowing us to%vrk safely. <br /> •If metals are requested for water samples and the water type(Matrix)is not specified on the chain of custody,MAI will default to metals by E200.8. Comments/Instructions <br /> Please provide an adequate volume of sample.If the volume is not sufficient for a MS/MSD a LCS/I.CSD will be prepared in its place and noted in the report. <br /> Relies quished By i Company Nome Date Time Receival By/Company Name Datc Time <br /> 2 ( !f to Plot) <br /> Matrix Code:DW=Drinking Water,GW=Ground Water,W W=Waste Water,SW=Seawater,S—Soil,SL=Sludge,A=Air, WP=Wipe,0=Other <br /> Preservative Code: 1=40C 2=HCl 3=H,SOe 4=14NOa 5=Na01-T 6=ZnOAC/NBOIT 7=None Temp °C Initials <br /> Page_of_ <br /> Page I"f 11 <br />