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M P D S Services, Inc. <br /> 2401 Stanwell Drlvs Sults 400, COnCOrd, CA 94520 <br /> TW 1510) 602 6120 Fax 16101 689-1918 <br /> CHAIN OF CUSTODY <br /> SAMPLER UNOCAL ANALYSES REQUESTED <br /> STEVE BALIAN S!S # �5 Y CITY I' RACOY TURNAROUND TIME <br /> WITNESSING AGENCY ADDRESS 379q 7 C V Q w r Ol p <br /> X o a o <br /> SAMPLING (L FW- CL REMARKS <br /> SAMPLE 10 NO DATE TIME WATER GRAB COMP NO OF CONT LOCATION H 22 f. <br /> U watt <br /> ALU _ y Ian X <br /> THE FOLLOWING MUST gE COMPLETED BY THE LABORATORY ACCEPTING SAMPLES FOR ANALYSES <br /> RELINQUISHED BY D/AJTEITIM/E/! RECEIVED BY 1 HAVE ALL SAMPLES RECEIVED FOR ANALYSIS BEEN STORED ON ICE? <br /> /� <br /> ISIGNATU41 ISIGN TURE) 2 WILL SAMPLES REMAIN REFfUGERATED UNTIL ANALYZED? <br /> LS <br /> ISIGNATUREI ISCNATURE► 3 DID ANY SAMPLES RECEIVED FOR ANALYSIS HAVE HEAD SPACE? <br /> K3 O <br /> SIGNATURE[ [SIGNATURE) 4 WERE SAMPLES IN/APPROPRIATE CONTAINERS AND PROPERLY PACKAGED?(i Q-4— <br /> ISIGNATUREI ISIGNATUREI SIGNATURE }� TITLE DATE 4 <br /> It r 4 <br /> i <br />