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G _7 <br /> Excelchem 1135 W.Sunset Blvd.Suite <br /> Rocklin,CA 95765 CHAIN-OF-CUSTODY RECORD AND ANALYSIS REQUEST <br /> Laboratories Inc. Ph:916-543-4445 Fx:916-543-4449 <br /> Project Manager:Joe Trapasso Phone#:AS ABOVE Electronic Data Deliverables Request: Email Address: <br /> X .PDF JoeT(a)excelchern.net <br /> _Geotracker(Global got 11 <br /> Company/Address:AS ABOVE Fax#: AS ABOVE Other (rioiso specify) RUSH. X RETURN COOLER TO <br /> EXCELCHEM <br /> ANALYSIS REQUEST Page 1 of 1 <br /> Project Number/P.O#:2103218 Project Name: 2103218 Bin#: <br /> Due Date: <br /> Project Location: Sampler Signature: <br /> Work Order: <br /> M <br /> Method <br /> Sampling Container Matrix <br /> Preserved <br /> 0 <br /> Sample w 12 <br /> Z Q <br /> n = F— <br /> ID Date Time o � o ii X o <br /> E ° Cn w o <br /> o o a- w p o .o Cr LAB USE <br /> Q U c" ° _ = U z rn ¢ ONLY: <br /> Sample i 3/29/2021 15:05 X X X X X <br /> Sample 2 3/29/2021 15:05 X X X X <br /> sampic; 3/29/2021 15:07 X X X X <br /> sample a 3/29/2021 15:07 X X X X <br /> simple 5 3/29/2021 15:10 X X X X <br /> w <br /> Reli tush d Date Time Received by: McCampbell Analytical-925-252-9262 <br /> 1534 Willow Pass Road <br /> (—'w/001 ' Jul' " �� �� ittsburg, CA 94565-1701 <br /> I <br /> Relinqui"shed,ly: Date Time Received by Labor tory. <br /> Excelchem Environmental Laboratories <br /> � / <br /> Iage 15 of 16 <br />