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General COC MAI Work Order It �g Vy D V 0 <br /> fi O McCAMPBELL ANALYTICAL, INC. <br /> CHAIN Or CUSTODY RECORD <br /> O1534 Willow Pass Rd, Pittsburg,Ca,94161-1701 Tum Around Time:l Day Rush 2 Day Rush 1 3 Day Ruch STD Quote# <br /> �O Telephone:(377)252-9262/Fax:(925)252-9269 1-Flag%MDL ESL Cleanup Approved Bottle-Order I <br /> www.mcc, bell coni main(a nlccampbelLcom Delivery Format: PDF GemTrlcker EDF EDD I Write On(DW) f_QuIS <br /> Report To:Tamara K.Woods Bill To:tkwoods@terracon.com Analysis Requested <br /> Company:Terracon Consultants, Inc.,902 Industrial Way, Lodi, CA r <br /> Email: tkwoods@terracon.com O M <br /> Alt Email:tamara.woods@terracon.com Tele: 209-269-8586 Ch <br /> UJ CV <br /> Project Name:Flag City#4 Project tt:NA187043 t LO <br /> Project Location:5184 Highway 12, Lodi, CA 'O It z W <br /> � <br /> t <br /> Sampler Signature: 41,Y7 U) <br /> l ` s W <br /> N <br /> SAMPLE ID Sampling (� 0 <br /> Location/Field Point Matrix Preservative Z 0 0 <br /> Date TimR <br /> c <br /> 2 <br /> MAI clients MUST disclose any dangerous chemicals known to he present in their submittal samples in concentrations that may cause immediate harm or serious future health endangerment as a result of hricf.gloved,open air,sample handling by MAI staff. <br /> Non-disclosure incurs an immediate SMO surcharge and the client is subject to fill legal liability for harm suffered.Thank you for your understanding and for allowing us to%%ork safely. <br /> *If metals are requested for water samples and the water type(Matrix)is not specified on the chain of custody,MAI will default to metals by E200.3. Comments-Instructions <br /> Please provide an adequate volume of sample.If the volume is not sufficient for it MS/MSD a LCS%LCSD will be prepared in its place and noted in the report. <br /> Relinquished B /Con any Name Date (�Time Received By/Company Name Date Time <br /> J 3 is" l Z- O '91kgha 12. <br /> Matrix Code: DW=Drinking Water,GW=Ground Water, WW=Waste Water,SW=Seawater, S=Soil,SL=Sludge,A=Air,WP=Wipe,O=Other <br /> Preservative Code: 1=4°C 2=HCI 3=I-I,SO4 4=14NOI S=NaOH 6=ZnOAc/NaOH 7=None Tenlp 4 ' °C Initials <br /> Page I'sge 6,&R 0 <br />