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® McCampbell Analytical,, Inc. <br />OTURN <br />® 1534 Willow Pass Rd. /Pittsburg, CA 94565-1701 � <br />www.mccampbell.com / main@mccampbell.com O'\ 1 <br />Telephone: (877) 252-9262 / Fax: (925) 252-9269 <br />CHAIN OF CUSTODY RECORD <br />AROUND TIME: RUSH 1 DAY 2 DAY 3 DAY 5 DAY <br />� � � � ❑ <br />GeoTracker EDF U PDP ❑ EDD ❑ Write On (DW) ❑ EQu1S 10 DAY )� <br />Effluent Sample Requiring,,r nag (a UST Clean Up Fund Project; Claim 9— <br />Re ort To: Kiersten Hoey Bill To: GHD —Kiersten Hoey <br />Report <br />nal <br />sis Req <br />uest <br />Company: GDA <br />Q <br />n°; <br />b <br />v <br />c <br />fl <br />b <br />d <br />— <br />H <br />O <br />^t <br />z <br />o. <br />o <br />W <br />U <br />o <br />M <br />$ <br />e <br />'q <br />O <br />f <br />x <br />5900 Hollis St, Suite A, Emeryville, CA 94608 <br />Tele: 510 420-3347 E -Mail: Kiersten.hoe hd.com <br />Pro ect #: 11103471 Project Name: Chevron 201383 <br />Project Location: 1930 W. llrh St c CA Purchase Order# 34004571 <br />re: <br />Sampler Si natu09 <br />SAMPLE ID <br />Field Pan <br />Name <br />SAMPLING <br />c <br />U <br />MATRIX <br />METHOD <br />PRESERVED <br />Date <br />Time <br />3 <br />; <br />e <br />3 <br />ea <br />a <br />e <br />v <br />V <br />Y <br />Te <br />54 <br />y� <br />-2- <br />IhIft, <br />40 <br />1 <br />1_ <br />�1 <br />x <br />x <br />**MAI clients MUST disclose any dangerous chemicals known to bq present In their submitted somples In concentrations that may cause Immediate harm or serious future health endangerment as a result of brief, gloved, open air, sample <br />handling by MAI staff. Mon -disclosure Incurs an Immediate $250 surcharge and the client is subject to full legal IlablIlly for harm suffered. Thank you for your understanding and for allowing us to work safely. <br />••• If metals are requested for water sam les and the water Ivya Is not s ecified on the chain of custody, then MAI wI11 default to metals by E200.0. <br />Relinquished By: <br />Dae: If <br />Time: <br />Rec d By., <br />ICE1t• COMMENTS: �� n �v <br />GOOD CONDITION ` X <br />HEAD SPACE ABSENT SSC �f v 1eS+ <br />DECHLORINATED IN LAB T" <br />APPROPRIATE CONTAINERS� (� G <br />PRESERVED IN LAB ! <br />VOAS O&G METALS OTHER HAZARDOUS: <br />PRESERVATION pH<2 <br />Relinquished By: <br />ate: <br />Time: <br />ved Pe. <br />Relinquished By: <br />Date: <br />Time: <br />Received By: <br />P <br />Page 15 of 17 <br />ok <br />