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�■n �s r r r r r r �r r� r u■� r ■r) a� r r A r <br /> OG Mccampbell Analytical, Inc. CHAIN OF CUSTODY RECORD <br /> WG 1534 Willow Pass Rd./Pittsburg,Ca.94565-1701 TURNAROTIME:Rusxp 2alrn❑Jas HR O n HE O s DAY ovAv <br /> www.mccampbell.com/ main@mccampbell.com GeoTmcker EDFQ PDF❑' EDD[]] Write On(DW)❑l EQuIS❑; <br /> Telephone: )877) 252-9262/Fax: )925) 252-9269 <br /> Effluent Sample Requiring"J"Dag❑] UST Clean Up Fund Project;Claim# <br /> Re ort To: Bill To: Analysis Request {— <br /> Company: C <br /> 0 <br /> F <br /> o Oi :a <br /> E-Mail: 21 <br /> Tele: Fax: 9 <br /> a .. e <br /> Pro'ect#: Pro'ect Name: g = z o 5 a a <br /> Pro'ect Location: Purchase Order# <br /> S U < c o d <br /> Sampler Signature: a<, <br /> MATRIX <br /> METHOD e�"o U 5 .- Z v O <br /> SAMPLING PRESERVED a F -�, �' o e y <br /> O O O Si Z U �: v W O N O G <br /> Location/ 2 <br /> SAMPLE ID <br /> Field PoinTDateTime <br /> Name <br /> C .3 CS � <br /> at e y ,a •0 ': e a V e F Y `o `0 I'm w 4 w w w L w u '. <br /> at C'1 3 a y y Q in 0 x O m F F F F W W W W W W W V .1 g fx, <br /> �( v — lT7 Lo d i 8 1 �: sa <br /> X 3: 56 el <br /> 3: ; a <br /> -'MAI clients MUST disclose any dangerous chemicals known to be present in their submitted samples in concentrations that may cause immediate harm or serious future health endangerment as a result of brief, <br /> gloved,open air,sample handling by MAI staff.Nondisclosure incurs an immediate$250 surcharge and the client is subject to full legal liability for harm suffered. Thankyou for your understanding and for allowing <br /> os to work safe) . <br /> Relinquished By: Date: Time: ed ICE/t• COMMENTS: <br /> GOOD CONDITION Sam?tr IzC, LNSy oh.S <br /> l HEAD SPACE ABSENT_ <br /> Relinquis Date: Time: i By: DECHLORINATED IN LAB pp -Z <br /> APPROPRIATE CONTAINERSP <br /> _ cel) <br /> PRESERVED IN LAB_ <br /> Bell ✓ shed`By: ate: Time: lKeived By: VOAS O&G METALS OTHER HAZARDOUS: <br /> PRESERVATION pHQ <br /> Page 25 of 25 <br />