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M P D Services, Inc. • CHAIN OF WSTODY <br /> 2401 Stanwell Drry , Sulte 400, Concord CA 94520 <br /> ` M <br /> Tel (510) 602 5120 Fax (510) 689-1918 <br /> SAMPLER iUNOCAL _ ANALYSES REQUESTED <br /> Us}r�rk�s TAS YJ'Ir4A/ S/S # o/ 23 CITY ! TURN AROUND TIME <br /> WITNESSING AGENCY ADDRESS lc,j -U d <br /> CQ <br /> SAMPLING � j <br /> SAMPLE ID NO DATE TIME WATER GRAB COMP NO OF CONT LOCATION REMARKS <br /> X X f A � c'/dr X x X <br /> tj rPff�l� u�C <br /> /I 33 X X X X '7 9 01 SS <br /> THE FOLLOWING MUST BE COMPLETED BY THE LABORATORY ACCEPTING SAMPLES FOR ANALYSES <br /> RELINQUISHED BY DATE/TIME RECEIVED BY 1 HAVE ALL SAMPLES RECEIVED FOR ANALYSIS BEEN STORED ON ICE? <br /> (SIGNATURE) CJ y, 15 EI 2 WILL SAMPLES REMAIN REFRIGERATED UNTIL ANALYZEO7 �J <br /> {!SIGNATURE (SI ATUREI 3 DID ANY SAMPLES RECEIVED FOR ANALYSIS HAVE HEAD SPACE? <br /> 154GNATURE) RE► LI 4 WERE SAMPL IN APPROPRIATE CONTAINERS AND PROPERLY PACKAGED? <br /> 2 <br /> ISIGNATUREI (SIGNATURE) SIGNATUK TITLE kA4 DATE <br />