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Obi McCampbell Analytical, Inc. <br /> CHAIN OF CUSTODY RECORD <br /> 1534 Willow Pass Rd.!Pittsburg,Co.94565-1701 TURN AROUND TIME:RUSH❑ 24 51R I1 n8 HR dr_HR DAY ❑ <br /> www.mccampbell.com/ main@mccompbell.com Gcv,Trucker EDF PDF❑ EDD[a Writc On IDWi❑ FQuIS❑ <br /> Telephone: (877(252-9262/Fax: (925) 252-9269 <br /> Efllucnt Sample RequL•int;"J"Hag❑ ❑5"f Clean hp Fund Project❑;Claim J7 <br /> Rc ortl'o: r d 7�Awca Bill To: .,ES Ants vsisRequest <br /> Company: <br /> 'a" a �a7.t(tangwlE;vs .r m e J <br /> E-MaII• - - - <br /> Tele kTC a'ta Fax: <br /> Project#: 1-k oU Protect Name. rn c <br /> _ y = E ! <br /> Pro'ect Location: ;A� rP Purchase Orden U 4i u _ = _ ^ 7 x g <br /> Sam ler Signature: <br /> MATRIX <br /> SAMPLIN _ _ - - <br /> PRESERFEU < ! " in <br /> tioni <br /> SAMPLE til X a c• S r x. - m •O _ / = -z s <br /> :icld Pain m r - r ;% f- : r i= - m •+ '• o c 5 <br /> Name Date Timeis <br /> •+ y e 'G - y e` e 3 3 w h v. "� r a <br /> _ 4 n - <br /> a c S F < v. - •� at - 4 f <br /> clients MUST disciose any dangerous chemicals known to he present In their submitted samples to ennventntlons that may cause immediate harm or serious furore heahh cudnngerment as a rcsuh of ANef. <br /> gloved.open air.sample handling by NLU uaff.Non-disclosure incurs an immedime S2$a surcharge and the client is subjml to fall legal liability for harm suffered. 1'bank you for sour understanding and for allams inn <br /> us to work safely. <br /> Relinquished By: Date: Time: / HEAD ICut'CoOCOMMENTS: <br /> r ��_D/ <br /> V K e CONDITION_ <br /> S� HF.•\DSP:\[E ABSENT I <br /> Relinquis ed By: Date: Time: Rtccived Bv: utr DLORI:NATED IN LAD_ <br /> APPROPRIATE CONTAINERS_ <br /> PRESERVED IN LAB,_ <br /> Relinquished By: Onto: 'Time: Receind RcVOAS O&O METALS OTHER HAZARDOUS: <br /> PRRSERV 11'ION __pHc? <br /> Page 3 of 11 <br />