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General COC USH MAI Work Order# <br /> O McCAMPBELL ANALYTICAL, INC. <br /> CIIAIN OF CUSTODY RECORD <br /> 1534 Willow Pass Rd. Pittsburg,Ca.94565-1701 Turn:round Time:l Day Rush I X12 Day Rush 3 Day Rush STI)l I Quote , <br /> WO Telephone: (877)252-9262/Fax:(925)252-9269 )-rlag/Mnl. FSL Cleanup Approved Dry weight _LjBottle Order i/ <br /> www.mccampbell.cotm main(&mccampbell.com Delivery Format PDI' (icoTracker FDF FI)DI I Write On(D\V)J I Detect Surnmary <br /> Report To: Bill To: P0 O'D 6 Analysis Requested <br /> Company: G� EZ E1�v120 2 -S I1J c ° <br /> .0 .L.. O <br /> Address: <br /> Email: 70T^ - <br /> Project Name:, y (�� Project#: Zp_ (7 r _ y a ° = y <br /> ry O O V O <br /> Y I_ I U i <br /> Project Location: o e,A. PO# 7 7S'7 <br /> Sampler Signature: e <br /> V G ` u V tJ u u V G b n _ <br /> TY V •d VSampling Z - --r y <br /> N vSAMPLE ID G <br /> aveMatrix Preseryx L <br /> Location/Field Point N Or- <br /> H Y <br /> Date Time -_ <br /> F o. = a — o — —0 — <br /> i O C7 F v'; F� '✓; F J; F- C7 E— i [ad :.] :il W ta: U <br /> Y <br /> MAI clients MUST disclose any dangerous chemicals known to be present in their submitted samples in concentrations that may cause intntediate hams or serious future health endangerment as a result of ,brief.glosed,open air,sample handling by MAI staff <br /> Non-disclosure incurs an immediate 5250 surcharge and the client is subject to full legal liability for harnt suffered.Thank you for your understanding and for allowing us to.cork safely. <br /> 'If metals are requested for water samples and the water type(Matrix)is not specified on the chain of custody.MAI will default to metals by E200.8. Comments Instructions <br /> Please provide an adequate volume of sample.If the volume is not sufficient for a MS/MSD a LCS/LCSD will be prepared in its place and noted in the report. / ' <br /> Relinquished By;Company Name Date Time Received By i ComJ v Name Date Time U �l/ v v <br /> Matrix Code: DW=Drinking Water,GW=Ground Water, WW=Waste Water, SW=Seawater, S=Soil, SL=Sludge,A=Air. WP=Wipe,O=Other <br /> Preservative Code: 1=4'C 2=1-I0 3=H_'SO4 4=HNO, 5=NaOH 6=ZnOAc"NaOII 7=None '1 unp ��rLN�� Initials v <br /> /P:l 1a_V 2 �f 23 <br /> i sC <br />