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1 <br />�I <br />Tr <br />M <br />a <br />Page 19 of 20 <br />CHAIN OF CUSTODY RECORD <br />McCampbell Analytical, Inc. <br />d <br />1534 Willow Pass Rd. / Pittsburg, CA 94565-1701a .t <br />P <br />tt A11OtND TIM E: RUSt1 1 nnv z DAY ❑ DAY ❑ s DAY ❑ <br />www.rrtccctmpbell.com / main@rmccampbell.com <br />Gur sacro ED ❑ I'DP ❑ FDD ❑ write On (I)4Y) ❑ l:QulS ❑ 10 DAY ❑ <br />Telephone: (877) 252-9262 / Fax: (925) 252-92W69 <br />1 u <br />I;ftlrtcnt Snmplc Rcyuirin{; ",I" Ilrt};❑ lt5'1' Clctlnp Fund lit'roject Q; C'laitn li <br />Re ort.l'o _Kiersten lion — [rill To: GIID-Kiersten Iloey <br />Analysis <br />Rem <br />nest <br />Com )any:GDti _-- — -_—_-- <br />c <br />3 <br />'' <br />:g <br />'-. <br />06O_ <br />� <br />9 <br />s <br />_ <br />�. <br />. <br />A <br />E <br />2 <br />o <br />'Al� <br />7 <br />� <br />5900 Hollis St, Suite A, Emeryville, CA 94608 <br />Tele: ( 510 ) 420 -3347E -Mall: Kielsten.hoe�'@glld.com <br />Project #: 11103471 Protect Name: Chevron 201383 _ <br />_ <br />Project Location: 1930 W. 11`I' St, Tr A Purchase Order# 34004571 <br />Sampler Signature: <br />6A�- <br />t- <br />_ <br />3 <br />$ <br />� <br />`fj <br />u <br />E <br />b <br />= <br />0 <br />� <br />U <br />° <br />% <br />f <br />" <br />N <br />r•tEnum <br />SAM{ LING <br />MATRIX <br />PRESERVED <br />V <br />; <br />S <br />F' <br />_y <br />x <br />k!0 <br />;n <br />x <br />fL <br />LK <br />_ <br />SA!11PLE, ill <br />t,.00H111r111 <br />meld i uin <br />� <br />� <br />, <br />3 <br />_ <br />� <br />' <br />3 <br />� <br />3 <br />y <br />` <br />x <br />x <br />� <br />; <br />= <br />' <br />= <br />`^ <br />< <br />L <br />Nnlrre <br />Date'Time <br />3 <br />4' <br />y <br />3:•, <br />— <br />c:�' <br />1 <br />'1 <br />_ <br />q� <br />Z <br />C.I <br />Xt <br />V <br />a <br />3 <br />C <br />A <br />q <br />p <br />n <br />%f <br />7 <br />o <br />N <br />y <br />O <br />5 <br />Q <br />T <br />y <br />O <br />6sj <br />n <br />r <br />�'i.rr. <br />r- <br />r. <br />w <br />a <br />t <br />_J <br />5 <br />n <br />F <br />lz - 3- <br />--DW <br />1 <br />y- <br />x <br />i0125 <br />X <br />x <br />D <br />k <br />X <br />AT 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, glovod, w�lr, sample <br />+� <br />handling by MAI staff. Non•dhclosure Incurs an Immediate $250 surcharge and the client Is subject to full legal liability for harm suffered. Thank you for your understanding and for allowing us to work safely. <br />— It metals are requested for water earn les and the water ty Is not specified on the chain of custody, then MAI will default to metals by E200.8. <br />Refill ui I I Ii,: <br />-- _. <br />Dn" <br />1/( <br />'['line: <br />Recei <br />I(T./t" COMMENTS: <br />-MOD CONDITION O - <br />-�_ <br />uE:nn SPACE ABSENT9 <br />I)ECIILORINATFI) IN LAB <br />Relinquished Rv! <br />Date: <br />lime: <br />Receis <br />to <br />Ai'1'ROPRIATE (:ON•rA1NERS � o <br />I'll ESE 11VED IN LAB <br />YOAS O&G ME:1'AI,S OTIIER IIA•LARDOt1S: Z-1� <br />Relinquished 11). <br />Dnte: <br />Time: <br />Received By: <br />I'll F,SERVAIION pll<2 r <br />1 <br />�I <br />Tr <br />M <br />a <br />Page 19 of 20 <br />