Laserfiche WebLink
General COC <br />MAI Work Order #– –;7 /CJ C7,1�7,q <br />O McCAMPBELL ANALYTICAL, INC. <br />O1534 Willow Pass Rd. Pittsburg, Ca. 94565-1701 <br />W Telephone: (877) 252-9262 / Fax: (925) 252-9269 <br />O www.mccamphell.com main 6ncearn helLcom <br />CHAIN OF CUSTODY RECORD <br />burr, Around I ime:I Day Rush 12 Day Rush 3 Day Rush STD Quote # <br />J-19ag'>1DI. FS1. Cleanup Approved Dry Wcieht Bottle Order `I <br />Delivery Format: PDF 6coTracker FIVI FDD 111r to Un (D\Vl Detect summand <br />Report 'l'o:TAMARA WOODS Bill To: MACY HUMPHREY <br />Analysis Requested <br />Company: TERRACON LODI <br />C:) <br />c7 <br />w <br />z <br />Q <br />w <br />Q <br />Z <br />M <br />�: <br />C\l <br />L0 <br />W <br />U <br />m <br />Q <br />I:mai I: TAMARA.WOODS@TERRACON.COM <br />Alt Email:TONY.MIKACICH@TERRACON.COM Tele: 209-269-8586 <br />Project Name:EHLERS PROPERTY Project �i: NA217019 <br />Project Location:9220 HIGHWAY 12, LODI, CA PO 4 <br />Sampler Signature: <br />SAMPLE ID <br />Location / Field Point <br />Sampling <br />Matrix <br />Pre,ervett\c <br />Date <br />Time <br />GW1 <br />1 <br />GW <br />• <br />GW2 <br />Lt T <br />I <br />2 <br />GW <br />• <br />TRIP BLANK <br />t �) <br />w t"3 .., <br />2 <br />mm client, mus di close amdangerous cbemicatn known to be present to their submitted samples in conc'e'ntrations that may cause immediate harm or serious future health en(l ntgennent as a result of hrief gloved. open air.sample handling by NIAI stall. <br />Non-di,closure incus On inmtediatc S250 surcharge and the client is subject to full legal liability for harm suffered. l -hank you for your understanding and for allowing us to work safely. <br />* If metals are requested for water samples and the water type (Matrix) is not specified on the chain of custody, MAI N% ill detmtlt to metals by (:200.3. <br />Comments / Instructions <br />Please pro%ide an adequate \'oltime of sample. If the volume is not sufficient for a V1SAISD a LCS;L('SD will he prepared In its place and noted in the report. <br />Relinquished R\ Company Name Date rime Received By i ('ontpany Name Date "Time <br />Matrix Code: DW=Drinkinu Water, GW=GrOlmd Water, WW=Waste Water. SW=Seawater, S=Soil, SL=Sludge. A=Air, WP=Wipe, O=Other <br />Preservative Code: 1=4°C <br />2=HCI 3=H,SO, 4=HNO, <br />5=NaOH 6=ZnOAcfNaOFI <br />7=None <br />A . . — I <br />/' <br />-- /l- . % <br />Tempe Initials <br />Pae, of <br />Page 10 of 1 1 <br />