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I >40)­10 Lf 7-- <br /> O � McCampbell Analytical, Inc. CHAIN OF CUSTODY RECORD <br /> WG 1534 Willow Pass Rd./Pittsburg,Co.94565-1701 TURN AROUND TIME:RUSH❑; 24 HR Q48 HR Oj 72 HR ❑ DAY M 1/0 DAY ❑ <br /> www.mccompbell.com/ main@mccampbell.com GeoTracker EDF❑J PDF❑j EDD❑j Write On(DW)❑j EQu1S❑; <br /> Telephone: (877) 252-9262/Fax: (925) 252-9269 <br /> Effluent Sample Requiring"J"flog Q] UST Clean Up Fund Projee[❑I;Claim# <br /> Re ortTo: ae$ Bill To: rypii 0, Anal sisRe uest <br /> Com an : v <br /> m <br /> F r <br /> ve <br /> E-Mail: SSTf 5 _ .. <br /> s <br /> Fax: <br /> Tele: a - ` <br /> _ m "^ <br /> • m = r 9 J <br /> Project#: v Pro'ectName: OR �° U a s - _ <br /> Purchase Order# <br /> Project Location: ,¢ 9 E a i <br /> a p y <br /> Sampler Si nahrre: e V m 0 o E ._ 0 o 0 v r r <br /> SAMPLING MATRIX METHOD y v H L a Q o r o <br /> PRESERVED G ? <br /> a -'- <br /> y <br /> Location/ v d . n z — x o `° 3 '^ e e <br /> SAMPLE ID Field Poin y 3 n 3 v a 'p S ,00 °° " N '!+ c 8 9 <br /> Name Date TimeS 2 <br /> 2 <br /> 3 m y V y y y V A v <br /> e „ <br /> V Z — <br /> ae O 3 G` :n` y 6 H O S O m r t- I•� f m m m m m m � u � � i:. <br /> I k X X I I I X <br /> (sa e5 s'- I w I k k <br /> 6aP"I,-= w5(d ) 1 1 1 IN I I I I I IV <br /> Wa- ,1,,u9 d <br /> V wa-m- S <br /> �( 1- TI-A Z 1 <br /> °-MAI clients MUST disclose any dongerous chemicals known to be present in their submitted samples in conceal rations that may cause immediate harm or serious future health endangerment as a result of brief, <br /> gloved,open air,sample handling by MAI stall.Non-disclosure incurs an immediate$250 surcharge and the client is subject to full legal liability for harm soRered. Thank you far your understanding and for allowing <br /> us to work relv. <br /> Rcl'nquished By: Date: Time: Received By: ICFJY COMMENTS: S h SLi f}f <br /> GOOD C ND ION_ <br /> HEAD SPACE ABSENT_ 46 S(]y1 ,�QS'�V+n �U• ' <br /> Relin uish y: Date: Time: c'v d Ry: DECHLORINATED IN LAB <br /> Y/� /�./ APPROPRIATE CONTAINERS L- 141). Sfl ljl(il ttl/� �tS�7�m� <br /> f- 7/V/9 �b%4 PRESERVED IN LAB CGH Nell C)• 49CtUSP1 -.4J�F• <br /> Relinquished By: Date: Time: Received By: VOAS O&G METALS OTHER HAZARDOUS: `'V/ et=�• <br /> PRESERVATION OH¢ 1J <br /> A M r M M w M M M WK76 <br />