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M M M M M M i M M A i � � M M M r M ! <br /> General COC MAL Work Order# O v `4 (4q <br /> ® McCAMPBELL ANALYTICAL, INC. CHAIN OF CUSTODY RECORD <br /> O1534 Willow Pass Rd.Pittsburg,Ca.94565-1701 Tom Around Time:I Day Rushl 12 Day Rush 1 13 Day Rush STD X I Quote# <br /> WO Telephone:(877)252-9262/Fax:(925)252-9269 J-Flag/MDLI VsLJ I Cleanup Appmvcdl I Bottle Order# <br /> wrsvW.mccampbell,cont rimin(U)mccaninbell.com Delivery Format: I PDF I GeoTmckcr EDFJ I EDDI I Write On(DW) EQuIS <br /> Report To: iDCiniL t,- Bill To: n[inlLl KYUII\L{- Analysis Requested <br /> Company: )x:11 C �ILIIC FIlLil'LL.(,ILII lC It 7C _ = <br /> EmaiL• t1kF�ltlli.',.I- �� �T} dli,Cl�- Lut�'1 _ %I S o � T e z `e S <br /> Alt Email: I'VI ct-11'Yl ?oS c, �(,7 r�L1 OC IY. Un1�Tele: (2[��14o:. - SlZ9 0 0 _ - = _ _ a E cY <br /> e` `a p, s i a° `s O O S U <br /> Project Name: (LD itiI Q S NL S Project#: m < < e3 3I o h > e; <br /> Project Location: 4255o ilcu-evNu Fit PO# + + _` <br /> v = u Z <br /> Sampler Signature:� G h -- _ =� m t e a e <br /> C C u— a3 uSamplingSAMPLE ID at <br /> Om u S c <br /> U r <br /> GF3 u Pe'A Matrix Preservative <br /> el <br /> Location/Field Point x - — :I eDate Time be <br /> +_ <br /> e <br /> OhSIlk wYll �p5c lRS4l�llly -Ire 3 avy 2 <br /> MAI clients MUST disclose any dangerous chemicals known to be present in their submitted samples in concentrations that may cause immediate harm or serious future health cndungermcm as a result ofbrief gloved,open air,sample handling by MAI staff. <br /> Non-disclosure incurs an immediate S250 sumharge and the client is subject to fail legal liability for harm suffered"thank you for your understanding and for allowing us to work safely. <br /> •If metals arc 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 Rec ' y/Company Name Date nn Time <br /> Matrix Code: DW=Drinking Water,GW=Ground Water,W W=Waste Water,SW=Seawater, S=Soil,SL=Sludge,A=Air, WP=Wipe,O=Other <br /> Preservative Code: 1=4°C 2=HCI 3=H,SO, 4=HNO, S=NaOH 6=ZnOAc/NaOH 7=None Tem OC Initials <br /> Page_of <br /> Page 7 of 8 <br />