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M P D #Services, Inc. ' <br /> 2401 Stanwell Drive, Suite 400, Canard, CA 94620 <br /> TN (610) 602 6120 Fax (610) 688 1918 <br /> CHAIN OF CUSTODY � • <br /> SAMPLER UNOCAL _11 / ANALYSES REQUESTED <br /> VARTKES TASHDJIAN S1S # i CITY cS ALJ6/C l- TURN AROUNE? TIME <br /> Lu <br /> WITNESSING AGENCY ADDRESS 16(d V �. L9�[ C. uj <br /> t7 x p Q <br /> SAMPLING a fL O o REMARKS <br /> SAMPLE ID NO DATE TIME TE RAA COMP NO OF CONT LOCATION H c4 F <br /> mw zj� j� Z Vo 141 m o x 21 -7� <br /> MW z- 1 qz. <br /> M t'r'I 3 jq 111 <br /> lq3 <br /> lqGj lq32, <br /> THE FOLLOWING MUST BE COMPLETED BY THE LABORATORY ACCEPTING SAMPLES FOR ANALYSES <br /> RELINQUISHED BY' ATI T E RECEIVED BY I I HAVE ALL SAMPLES RECEIVED FOR ANALYSIS BEEN STORED ON ICE? <br /> K I 2-11+t/9 <br /> i51G U f�5 (SIGNATUREI / ) 2 WILL SAMPLES REMAIN REFRIGERATED UNTIL ANALYZED? <br /> �`ag ��i/', "-- >-5 <br /> IISIGNATURE) I ISIGNATUREI 3 DID ANY SAMPLES RECEIVED FOR ANALYSIS HAVE HEAD SPACE? <br /> {SIGNATUAEJ (SIGNATURE) 4 WERE SAMPLES IN APPROPRIATE CONTAINERS AND PROPERLY PACKAGED? <br /> ISIGNATUREI (SIGNATURE) SIGNATURE TITLE DATE � <br />