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M P D 0 Services, Inc. CHAIN OF WSTOD 'Y- <br /> 2401 <br /> Stanwell Drive Suite 400 Concord CA 94520 <br /> Tel (510) 602 5120 Fax 15101 689 1918 1 <br /> SAMPLER UNOCAL ANALYSES REQUESTED <br /> TLl S-H 71AA1 S/5 # 0/ 2 9 CITY Tr TURN AROUND TIME <br /> 1 3 • �° X <br /> WITNESSING AGENCY ADDRESS � �.�ZY7��—{ 1-lj <br /> 1 r <br /> — SAMPLING ��~ J <br /> SAMPLE ID NO <br /> PATE TIME WATER GRAB I COMP NO OF CONT LOCATION REMARKS <br /> AM � Aa��r nF :ASH <br /> t x x 1()fi .SS.i , /,ecl— <br /> /� 15 <br /> oITf IT, x x VOW .160 <br /> -7 X X X X `I ofi Jf Z <br /> THE FOLLOWING MUST BE COMPLETED BY THE LABORATORY ACCEPTING SAMPLES FOR ANALYSES <br /> RELINQUISHED BY DATEITIME RECEIVED BY 1 HAVE ALL SAMPLES RECEIVED FOR ANALYSIS BEEN STORED ON ICE? <br /> (SIGNATUREI (� cf �C ISIGNATUREI r 3((s 2 WILL SAMPLES REMAIN REFRIGERATED UNTIL ANALYZED? <br /> fl y 1,(i1-rN 'ei)(1mcel 2&/) <br /> ISIGNATUREI 1I ISIGNATUREI 3 DID ANYSAMPLES RECEIVED FOR ANALYSIS HAVE HEAD SPACE? <br /> � y <br /> ISIGNATUREI (61 (q00 IS]GfOA R 4 WERE SAMPLES IN APPROPRIATE CONTAINERS AND PROPERLY PACKAGED? 1 <br /> y <br /> (SIGNATURE) (SI(TNATUF&l SIGNATURE TITLE DATE <br /> --- _ _..�— ..-_ r r <br />