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Ox McCampbell Analytical, Inc. CHAIN OF CUSTODY RECORD <br /> O� 1534 willow Pass Rd./ Pittsburg. Ca.94565-1701 TURN AROUND TIME: to sli❑ I n:\ti-❑ z ImN,❑ ,n:\r ❑ ;DAY <br /> O www.mccompbell.com/ main,°mccampbell.com ccol rachrr I.uf❑ Put:❑ I QUN q lu 1W ❑ <br /> Telephone: (877) 252-9262/ Fax: (925) 252--9269 <br /> Effluent Sample Rcquirin,_,".I"Ila ❑ t'S'f('lean Up Fund Project❑:('!aim;"_ <br /> Report To: tx? Bill To: �✓l .knalvsis Request <br /> Com anv: v M>rt- <br /> A00 M(Ae_rl AJe dtc 2o' y <br /> E-Mail: &5M e t)V=-Z Q('•conn <br /> Tele: (Zopt ) ?N-i-Sboc> Fa x: <br /> Project : Project Nante: ,ax - <br /> Project Location: q — T ton (ZJ.Purchasc Orders <br /> X J <br /> Sampler Si:nature: `'; _ _ = " Q <br /> S.4�IPLlNG MATRIX METHOD _ _ _ — — _ > _ 1 O <br /> PRESERVED <br /> SAMPLE Ill = <br /> Field Point ` _ ,� x x _ 1 = o is <br /> \amC Date TtR1C rLz <br /> \h\I clients\It sn'disclose an%y dan2crous chemicals knm%n to be present in their submitter!samples in concentruions thaK t may cnuimmedsttc harm or serious ruturc heath cndan;crmctu is a resull or brief, <br /> loud,open air,sample handling by\lA1 staff.Non-disclosure incurs an immediate S2�0 surchuryc and the client is subject to roll 1 c-,nl liabilih ror harm sulTcred. I'bank Nou for%our undcrslnndin,and for allcm iuz <br /> us to murk`trch. <br /> Relinquish3,d By: Mile: Time: rijcccired B.N: ^ / IC'Eit" COMMENTS: <br /> //\\ �, , �=✓/ GOOD CONDI I-ION <br /> l 1.y ! < HEAD SPACE ASSENT <br /> Relinquished By: Datc: Time: 'Recched lid: DECHLORINATED INLAR <br /> APPROPRIATE CONTAI\ERS <br /> PRESER\ED IN LAB <br /> Relinquished Br: Dntc: Time: Rccvi%ed L'.: \'O,\S OIC: METALS OTHER HAZARDOUS: <br /> PRESERVATION p1I<2 <br /> Page 6 of 7 <br />