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O® McCampbell Analytical, Inc. CHAIN OF CUSTODY RECORD <br /> W® 1534 Willow Pass Rd./ Pittsburg, Ca.94565-1701 TURN AROUND TIME: RUSH Q, 1 DAY ❑, z DAY p a DAY U 5 DAY <br /> www.mccompbell.com / main@mccompbell.com <br /> Telephone: (877) 252-9262/ Fax: (925) 252-9269 GeoTracker EDF U PDF U EDD Ell Write On(DW)Q EQuIS [] 10 DAY❑ <br /> Effluent Sample Requiring"J"Rag[a UST Clean Up Fund Project U;Claim 4— <br /> Report <br /> Re ort To: i Bill To: Aual sis Re uest <br /> Company: <br /> Tele: ) -� - E-Mail: I cy {I <br /> Project#: Pro'ectName <br /> U uProject Location: Purchase Order# <br /> Sampler Si nature: 2 „° <br /> p o <br /> > r � <br /> SAMPLING MATRIX METHOD m c7 p: a` '„ O a, c <br /> :aPRESERVED N ^, aI ,a u a <br /> a a so o <br /> Location/ .`� U `� = m a N e °- <br /> SAMPLE ID u a E <br /> Field Poiu d w _ „ <br /> > o <br /> Name Date Time :° 3 3 0 •. o d _ `° W � � •:, & <br /> N b a <br /> ° 3 m <br /> V v w ° n •o <br /> is U Z <br /> a V 3 o ti h Q m O x m O m Fo• E°- w w w w w V .`�'i or n <br /> --ELL <br /> -------------- - - ---------- - - - - ----- <br /> -------------- - - ------------------- <br /> 1 M11 <br /> ..MAI clienh MUST dlsclose any dangerous chemicals known to be present In Iheh submlffed samples In concentralions that may cause Immed ate harm or serious future health endangerment as—are of bdef,gloved,open air,sample <br /> handling by MAI staff.Non-disclosure Incurs an Immediate$250 surcharge and the client Is subject to lull legal liability for harm suffered. Thank you for your understanding and for allowing us to work safety. <br /> —If metals are requested for water sam les antlthe wafer a Is not s ed n the chain of cuslo ,then MAI will default to metals b E200.8. <br /> C7 <br /> Relinquished By: Date. Time: R ve ICEIr O0 <br /> COMMENTS: <br /> D CONDITION <br /> HEAD SPACE ABSEN_T <br /> Relinquished By: Date: Time: Received By: DECHLORINATED IN LAB C <br /> APPROPRIATE CONTAINERS_ f— <br /> PRESERVED IN LAB <br /> Relinquished By: Date: Time: Received By: tD� <br /> VOAS O&G METALS OTHER HAZARDOUS: <br /> PRESERVATION pH<2 fV <br /> O_ <br /> CJ1 <br />