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General COC
<br />MAI Work Order #
<br /> 01)0
<br />7 ic$ McCAMPBELL ANAft1kJaine4.
<br />Pass Rd. Pittsburg, Ca. 94565-1701
<br />main(amccampbell.com
<br />717) 252-9262 / Fax: (925) 252-9269 ,
<br />11)Zushwl
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<br />CHAIN OF CUSTODY RECORD
<br />1534 Willow Turn Around lime I Da) Rush X 12 Day Rush' 3 Day STD 1 Quote #
<br />1-Flag / MDL
<br />4f7,'
<br />wwwinc # ESL. . Cleanup Approved
<br />ry eight
<br />Bottle Order Telephone:canipbel.ic(08n
<br />Delivery Format: PDF GeoTracker FDF EDI) I Write On (DW)1 I Dett.et Summary
<br />Report To: Avtertit„..“.J .&riA,{,44--- Bill To: Analysis Requested
<br />Company: (:,(A0 01/41101)111 Multi Range as Gas. Diesel. anti Nlotor—Oil (8021/8015) EITEX & TP11 as Gas (8021/ 8015) NITRE TP11 as Diesel (8015) + Motor Oil Without Silica Gel I imc TP11 as Diesel (8015) + Motor Oil With Silea Gel t .2 .- - ,
<br />= .-- s., ......
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<br />,•7: 7, Preservative Total Petroleum 11)drocarbons - Oil & Grease (1664 / 9071) With Silica Gel Total Petroleum Ilydrocarbons (418.1) With Silica Gel 8
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<br />r. o ,c, EPA 608 / 8082 PC1Cs ; Aroclors only EPA 524.2 /624 / 8260 (VOCs) EPA 525.2/ 625 /8270 (SVOCs) -:.•
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<br />.0 CAM 17 Metals (200.8 / 6020). ,Metals (200.8/ 602(1)" Raylands Requirements Lab. to filter sample for dissulsed metals anal)sis Address: /7.c- C I-A.& ..4:!;1,-- (.4Sr S'GRAtec-tivt-e)
<br />Email: 8,,,,t„...ilt-, ttc,,,,,, € ctecm. t-triftl. %-i3/ yz 1/47 / Z.
<br />Project Name: U1/4111/107) MAPTEZA FM PlOProject #: 4.161.0 1 tg4-}
<br />Project Location: Utitl{rwp PC)#. 1,U 2 t % LO \-5°6(
<br />Sampler Signature: • -----------c-----
<br />SAMPLE ID
<br />Location / Field Point D
<br />Sam )1itiu. e
<br />., Matrix
<br />ate
<br />1 5.6 A fiff/7( L3.1 o T; ''(..
<br />£//(r/, 1S-?0
<br />(330
<br />git/74 k
<br />MAI clients MUST disclose any dangerous chemical known to be i resent in their tibmitt d samples in co icentrations that may c use in medial • hann or serious future heal Ii endangerment as a esult of brief, gloved open ait, sample handling b - MAI tall.
<br />Non-disclosure incurs an immediate S250 surcharge and the client is subject to full legal liability for harm suffered. Thank you for your understanding and for allowing us to vork safely.
<br />' If metals are requested for %later 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 />V Wsi At CA\ MO1
<br />ktA,V 1A\IA-Q- -
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<br />Please provide an adequate volume of sample. If the volume is not sufficient for a MS/MSD a LCS/LCSD will he prepared in its place and noted in the report
<br />Relinquished By / Company Name Date Time Received By / Company Name Date Time
<br />linc,,,&-t-cct. itlre akibdrom"4- ll(11/?1 (al c rj•/a /C3 e
<br />AAP( abgA S72:51 /2a/
<br />Clt4,. ' triouv,kAe,-,--06-(
<br />,w1---Y- 12s -Az/ I / 3M- /---711'-
<br />Matrix Code: Code: DW=Drinking Water, GW=Ground Water, WW=Waste Water, SW=Seawater, S=Soil, SL=Sludge, A=Air, WP=Wipe, 0=Other
<br />Preservative Code: 1=4°C 2=HCI 3=1-12SO4 4=HNO3 5=NaOH 6=Zn0Ac/NaOH 7=None Temp J I . °C Initials
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