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SR0083976_SSNL
Environmental Health - Public
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SR0083976_SSNL
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Last modified
2/10/2022 9:33:35 AM
Creation date
8/9/2021 1:22:08 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2600 - Land Use Program
FileName_PostFix
SSNL
RECORD_ID
SR0083976
PE
2602
STREET_NUMBER
12184
Direction
N
STREET_NAME
HIBBARD
STREET_TYPE
LN
City
LODI
Zip
95240
APN
06323042
ENTERED_DATE
7/20/2021 12:00:00 AM
SITE_LOCATION
12184 N HIBBARD LN
P_LOCATION
99
P_DISTRICT
004
QC Status
Approved
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EHD - Public
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General COC MAI Work Order# <br /> MCCAMPBELL ANALYTICAL, INC. CHAIN OF CUSTODY RECORD <br /> 1534 Willow Pass Rd. Pittsburg.Ca.94565-1701 Tum Around Time:I Day Rush 1 2 Day Rush 3 Day Rush STD •�Order <br /> �O Telephone:(877)252-9262/Fax:(925)252-9269 3-Flag/MDL ESL Cleanup Approved Dry Weight Bo <br /> www.mccampbell.com main(amccampbell.com Delivery Format: PDF GeoTracker EDFJ EDDI IWrite On(DW)J I Detect Sunuuary <br /> Report To:Daniel Kramer Bill To: Daniel Kramer Analysis Requested <br /> Company:Petralogix Engineering <br /> Email:dkramer@petralogix.com <br /> Alt Email:tscheftner@petralogix.com Tele: 209-770-0731 _ .. <br /> Project Name:SSS)NLS-Hibbart Road Project#: M O <br /> Project Location:12172 Hibbard Road,Lodi PO# N M <br /> Sampler Signature: W lJJ <br /> SAMPLE ID Sampling tl Z m <br /> a N-latrix Preservative U A CL <br /> Location/Field Point Date l imcz <br /> DW 6118/2021 ,Q'.t0 5 DW <br /> MAI clients MUST disclose any dangerous chemicals knomi to be present in their submitted samples in concentrations that may cause immediate hams or serious tuturc health endangennent as a result of brief,gloved,open air,sample handling by MAI staff. <br /> Non-disclosure incurs an immediate$250 surcharge and the client is subject to full legal liability for harm suffered.Thank 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 will default o metals E200.8. Comments/Instructions <br /> Please provide an adequate volume of sample.If the volume is not sufficient for a MSIMSD a LCS/LCSD will be prepared in iti p ce an ed in the report. <br /> Relinquished By 1 Company Name Date Time Recei 1 Corp4ny ame Date Time <br /> Matrix Code:DW=Drinking Water,GW=Ground Water, W W=Waste Water, SW=Seawater,S=Soil, SL=Sludge,A=Air, WP=Wipe,O=Other <br /> Preservative Code: 1=4eC 2=HCl 3=H2SO4 4=HNO3 5=NaOH 6=ZnOAc/NaOH 7=None Tcmp °C Initials <br /> Page / of <br /> Page 10 of 11 <br />
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