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M P D * Services, Inc. t � i { I �� CHAIN OF IWSTODY <br /> 2401 Stanwell Drive Suite 400 Concord CA 94520 <br /> Tel 15101 602 5120 Fax 15101 689 1918 <br /> SAMPLER UNOCAL / ANALYSES REQUESTED = <br /> y¢,2 TkE S TAf HT1,9A1 S/S # D/ CITY -S7ac���z n TURN AROUND TIME <br /> ADDRESS /_�r ✓ !0e UJ �C AL1 /Q <br /> WITNESSING AGENCY A- 4.1 <br /> `W ll <br /> SAMPLING �� REMARKS <br /> SAMPLE 10 NO DATE TIME WATER GRAB COMP NO OF CONT LOCATION <br /> U Ji f��4 3' ' x x z ✓�3 .4y lJ x 13 0 119 <br /> Z �Mz X �( X x 1 1 1ti0 <br /> 3 s,s3 11 ( 1~1 <br /> 7111 <br /> U 5r /Z�16 ti X x <br /> LA 4 P' X X `� Ic x X l i 0 �5 <br /> 0 �f, <br /> Y <br /> THE FOLLOWING MUST BE COMPLETED BY THE LABORATORY ACCEPTING SAMPLES FOR ANALYSES <br /> RELINQUISHED BY DATE/TIME RECEIVED BY t HAVE ALL SAMPLES RECEIVED FOR ANALYSIS BEEN STORED ON ICE? <br /> �S 1d <br /> (SIGNATURE) (SIG REI 2 WILL SAMPLES REMAIN REFRIGERATED UNTIL ANALYZED? <br /> zo P �� (11 <br /> s <br /> (SIGNATUREf ISIG ATUREI / 3 DID ANY SAMPLES RECEIVED FOR ANALYSIS HAVE HEAD SPACEl <br /> C l <br /> ISIGNATURE) ISIG }fAEI " 4 WERE SAMPLES IN APPROPRIATE CONTAINERS ANO PROPERLY PACKAGED? <br /> 0 1 0es <br /> ISIGNATUREI ( A RE1 SIGNATURE TITLE b �k�� DATE 10 <br />