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General COC MAI Work Order# I,�IIGO <br /> ' n MCCAMPBELL ANALYTICAL, INC. CHAIN OF CUSTODY RECORD <br /> O1534 Willow Pass Rd.Pittsburg,Ca.94565-1701 Turn Around Time:1 Day Rush 12 Day Rush 3 Day Rush STD Quote# <br /> W� Telephone:(877)252-9262/Fax-(925)252-9269 1-Flagl MDL ESL Cleanup Approved Dry Weight Bottle Order# <br /> www.rnecampbell.com main mccam b�com Delivery Format: PDF GeoTracker EDF EDD Write on(DW) Detect Summary <br /> Report To: V"k MAa r.n Bill To: Analysis Requested <br /> Company: S Y t ASS V C ic- <br /> Email:— �SVtGSfoC�c.�S C O� ,� t <br /> Alt Email:WeN �G-r'a w"-c '� 'S()U'[ eke:0L1 1 f 2.L <br /> Project Name:5 i C V�-u p Project t!: r ZVU I(t vI I� <br /> � L S <br /> Project Location: 5, OC � n C PO# -r-78 0 16 t)t rr.0 v L�_UU 1 <br /> Sampler Signature: Z116' <br /> SAMPLE ID <br /> Sampling p �' <br /> G Matrix Preservative <br /> Location/Field Point Date Time <br /> 3 6 Tjune X <br /> " t 1 16123 a, lu 1 S NIN"e x <br /> ...1 - `� t� ` 't7c�127 0('w I x <br /> NLU clients MUST disclose any dangerous chemicals known to be present in their submitted samples in concentrations that may cause immediate harm OF serious future health endangerment as a result of brief,gloved,open air,sample handling by MAI staff. <br /> Nondisclosure incurs an immediate 5250 surcharge and the client is subject to fill legal liability for harm sufrered.Thank you for)vur understanding and for allowing us to work safely. <br /> •If metals arc requested for water samples and the water type(Matrix)is not specified on the chain of custody,MAI will default to metals by E200.8. J Comments/jnstructioos <br /> Phase provide an adequate volume of sample-If the volume is not sufficient for a MS/MSD a 1,CS/LCSD will be prepared in its place and noted in the report. l'(J J SCQ/4 t--fCG '-"`d <br /> Relinquished By/Company Name Date Time Received By/Company:Fame Date Time 4,� tJ5. � Tu� � L Z."r z �j 1"r�L— <br /> a !� <br /> Matrix Code:DW=Drinking Water,GW=Grottnd Water,WW=Waste Water,SW—Seawater,S=Soi1 L=Sludge,A=Air,WP=Wipe,O—Other <br /> Preservative Cade: 1=4'C 2=HCl 3=H'SO4 4=HNO3 5=NaOH 6=ZnOAc/NaOH 7=None Temp °C Initials <br /> I✓``i <br /> Page_of <br /> Page 21 of 23 <br />