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® MCCampbell Analytical, Inc. CHAIN OF CUSTODY RECORD <br /> O TURN AROUND TIME: 1(; ,n 241112 4s nR 7211K 5 DAY <br /> O 1534 Willow Pass Rd. / Pittsi�urg, Ca. 94565-1701 Q � �. � t� <br /> www.mccampbell.com / main@mccompbell.com Geo 1 r;,ckci.1,1>I El PDF U 11-1)1)U write On(DW)[a EQuIS [:J to DAY D <br /> Telephone: (877) 252-9262 / Fax: (925) 252-9269 <br /> Effluent Sam rle Requiring"J"flag US"1'Clean U Fund Project Claire# <br /> I S I 1 � i; UP J �.: <br /> Report To: - Bill To: 91.rel Analysis Request <br /> Company: A o 5 c 5 le4g 5 s <br /> E-Mail: L!. 5�w ✓tea„ �Se , r — - <br /> Tele: (7,C61 7 LJ-7- I CC,p Fax: <br /> x + ^ <br /> Project#: I _71)0 6 Project Name: 5 E qac SCc r <br /> Project Location: L � ', Purchase Order# i• <br /> x v .^. <br /> Sampler Signature: - J ? — = N T <br /> SAMATRIX \IIalIOD c: <br /> MPLII C <br /> SAMPLE ID Location/ 'u = _ E = Y v. :. <br /> C a ` y x x oc " v: ' x v <br /> Field Point <br /> = - - - _ <br /> - - _ - = c ti <br /> Name Date Time i =r = _ _ _ _ N o v -Z <br /> w 1 (OA; Z x <br /> 2-i I XYl- <br /> _ <br /> F1 <br /> ** IAI clients MUST disclose anydangerous chemicals knot%n to he present in their submitted samples in concentrations that may cause immediate harm or serious future health endangerment as a result of brief, <br /> gloved,open air,sample handling by NIAI staff.Non-disclosure incurs an immediate 5250 surcharge and the client is subject to full legal Iiahility for harm suffered. Thank you for your understanding and for allowing <br /> us to%%urk safeh. <br /> Relinquished By: Date: Time Kc c It ICE/t° Cp11NIEN I S: <br /> f ( �`I_',� I ,>�\ GOOD CONDITION <br /> U I IEAD SPACE ABSENT <br /> Reli u'. ql l D tc: time: I ched B vDI-TllI.ORINA,rED IN LAB <br /> APPROPRIATE CONTAINERS <br /> ^-� PRESERVED IN I.AB <br /> R nygiishctl Date: I'imc: Rcccisc_ VOAS OX(: 1Ih'G4LS OTHER IIA%ARDOt S: <br /> I'llESERVATION_ pll<2 <br /> Pa�c 9 f10 <br />