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M P D S Services, Inc. <br /> 2401 Stanwall Drive, Swis 400, Concord, CA 94620 _ <br /> Td (6101 602 5120 F". 1510) 669-1918 <br /> CHAIN OF CUSTODY T ` <br /> SAMPLER UNpCAL I ANALYSES REQUESTED <br /> VARTKES TASHDJIAN 5!S CITY f c �'f G TURN AROUND TIME <br /> w �,�.1 <br /> WITNESSING AGENCY ADDRESS 5 6 6 /,CA-C'j Q- d w <br /> E? x c Illc� Q <br /> SAMPLING 4 4 O � REMARKS <br /> SAMPLE ID NO DATE TIMEATTR GaA COMP NO OF CONT LOCATION h- to E. <br /> LO B 0 <br /> acs ! z x Y X <br /> �� >r� x x X <br /> 4 � QG <br /> THE FOLLOWING MUST BE COMPLETED 8Y THE LABORATORY ACCEPTING SAMPLES FOR ANALYSES <br /> RELINDUI D BY DATEMME RECEIVED BY I HAVE ALL SAMPLES RECEIVED FOR ANALYSIS BEEN STORED ON ICE? <br /> ISKi TUFT �^ �� 1 NA Ul <br /> 2 WILL 5AMPLFS REMAIN REFRIGERATED UNTIL ANALYZED? <br /> ISIGNATURE? IlSitlaTURE) I ! / 3 DID ANY SAMPLES RECEIVED FOR ANALYSIS HAVE HEAD SPACE? <br /> L'nISIGNATURE? (SIGNATURE) 4 WERE SAMPLES IN APPROPRIATE CONTAINERS AND PROPERLY PACKAGED? <br /> `J <br /> ISIGNATUREI iSIGNATUREI SIGNATURE TITLE DATE / <br /> �] fI 7, � ,� tu_ L`t <br /> l <br />