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General COC <br />MAI Work Order # <br />MCCAMP$ELL ANALYTICAL, INC. <br />1534 Willow Pass Rd. Pittsburg, Co. 94565-1701 <br />Telephone: (8771252-9262 I Fax: [925) 252-9269 <br />www.inccami)bell.com main(@mccampbell.com mecampbell.com <br />CHAIN OF CUSTODY RECORD <br />Turn Around Time:I Day Rush 2 Day Rush 3 Day Rush STD Quote # <br />]-Flag 1 MDL.1 I ESLI Cleanup Approved I Bottle Order # <br />Delivery Format: GeoTracker EDF I PDFj <br />EDD Write On (DW) I I T;_ <br />Report To: Bill To: <br />Analysis <br />Requested <br />company: STM'V/C4'6�" <br />e <br />n. <br />u <br />7 <br />e <br />+ <br />a <br />o <br />u <br />iv", <br />a <br />-.42 <br />a <br />— <br />= <br />? <br />ca <br />a <br />v <br />a <br />n. <br />> <br />a <br />Q. <br />V_ <br />oa <br />a <br />e <br />< <br />oc <br />a <br />w <br />c <br />_ <br />i <br />s <br />E <br />Email:_ +-+� , 1�1�2rt� r? S'iE�trcY�cx ; evr� <br />Email: Tele: <br />Project Name/#:In <br />Project Location: PO # <br />Sampler Signature: <br />SAMPLE ID <br />Location / Field Point <br />Sampling <br />ro Matrix i'rescrvativc <br />Date <br />Time <br />**MAI clients MUST disclose any dangerous chemicals known to b •mt is it s omitted samples in concentrations that may cause immediate harm or serious future health endangertneni as a result of brief, gloved, open air, sample handling by MAI <br />staff: Non -disclosure incurs an immec a harge and the client is subject to full legal liability for harm sunered. Thank you for your understanding and for allowing us to work safely, <br />*** If metals are requeste N r water samples and the water type (Matrix) is not specified on the chain of custody, MAI will default to metals by E200.9, <br />Please provide an adequate volume of sample for testing being submitted. if the volume is not sufficient fora MS/MSD a LCSILCSD will be prepared in its place and noted in the report <br />Relinquished By I Company Name Date Time Received By/ Company Name Date Time <br />Comments I Instructions <br />13 ' <br />r <br />Matrix Code: DW=Drinking Water, GW=Ground Water, WW=Waste Water, SW=Seawater, S=Sail, SL=Sludge, A=Air, WP=Wipe, O=Other <br />Preservative Code: 1=4'C 2=HCl 3—H,SO4 4=HNO, 5=NaOH 6—ZnOAC/NaOH 7= -None <br />V <br />Temp °C Initials <br />Page _ of <br />Page 6 of 7 <br />