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General CO(' <br /> <br />NIA' Work Order <br />e McCAMPBELL ANALYTICAL, INC. <br />Pass Rd. Pittsburg. Ca. 94565-1701 <br />(877) 252-9262 / Fax: (925) 252-9269 <br />main(amccampbell.com <br />Willow <br />CHAIN OF CUSTODY RECORD <br />hun Atound lime • I Day Rush 2 Day Rush 3 Dav Rush STD • Quote # (1534 <br />tie) Telephone: .1-Flag N11/1. HSI. Cleanup Approved le Order Bottle <br />* www.tnccanmbell.com I kliver Format y : P1)06'201-tacker EDF <br />Night <br />mite on iv <br />m <br />giu)R <br /># <br />m Del et Sumary <br />Report To: TAMARA WOODS Bill To: MACY HUMPHREY Analys silltMe) Requested <br />Company: TERRACON CONSULTANTS INC '- <br />Q ,D n <br />W <br />Z <br />u) <br />I < <br />W <br />< <br />) CY 1..._ <br />— <br />'' <br />[1..._ DBCP - E524.3 Email: TAMARA.WOODS@TERRACON.COM <br />Alt Email: Tele: 209-712-7159 <br />Project Name: BUDDHIST TEMPLE Project #: NA177056 <br />Project Location: 11253 N. TI,N3RNTON ROAD, STOcKj.DN PO II <br />Sampler Signature: • /-.1 : 1 i L..------ <br />SAMPLE ID Sampling <br />Matrix Pic,:er‘ ills el <br />Location / Field Point I Date Time <br />GW-1 5-9-2018 411t7M01 GW <br />/ I <br />GW-2 5-9-2018 4r, V/S 2 GW .-,roaimcuro, <br />TRIP BLANKS <br />N1Alclients MUST disclose any dangerous chemical, known to be present in their submitted samples in co mentrations that inay cause m mediate harm or serious future heal II ends igermem as a iesult k f brief, gloved open air, sample handling by MAI staff. <br />Non-diselosme incurs an immediate $250 surcharge ; nd the client is suhicct to full legal liability for harm sufTeied Thank you for your understanding and for allowing US to kink si My <br />' flotilla's are requested for water samples and he water type (Matt ix) is not Tecified on the chain of custody. MM will default to metals by 0200 8. Comments / Instructions <br />Please provide an adequate volume of sample. I'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 I Company Name Dare Time Received By / Company Name I )ale Time <br />A,)1' Ht.99 / , 1, ,- Ii - <br />Matrix Code: DW=Drinking Water. (lW -Ground Water, WW=Waste Water, SW=Seawater, S=Soll, SL=Sludge, A—Air, WP=Wipe, 0—Other <br />Preservative Code: 1=4°C 2=FICI 3 •ILSO 1 4=-11NO3 5--NaOH 6=Zn0AciNa011 7 None Temp qq °C. Initials <br /> <br />Page of <br />Page 10 of]