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M P D Services, Inc. CHAIN OF OUSTGDY ' <br /> 2401 Stanwell Suite 400, Concord, CA 94520 r� } v <br /> Tel (510) 602-5120 Fax 15101 6891918 <br /> SAMPLER iUNOCAL ANALYSES REQUESTED <br /> S/S # 4/ Z 3 clTv _ 1'r 4L TURN AROUND TIME <br /> WITNESSING AGENCY ADDRESS 10 ! ate+' 4 l F <br /> V <br /> SAMPLING REMARKS <br /> SAMPLE ID NO <br /> DATE TIME WATER GRAB COMP NO OF CONT LOCATION <br /> GI7� l x /A J r LJt, X X x 10 493 <br /> Z ,z. Y, X X X X1703 49 si/;meq <br /> (� 3 /`'' r X x 7 X X x x 70:3(1495 <br /> /P +r X X X X x 03 498 <br /> lyy <br /> THE FOLLOWING MUST BE COMPLETED BY THE LABORATORY ACCEPTING SAMPLES FOR ANALYSES <br /> RELINQUISHED BY DATE/TIME RECEIVED BY t HAVE ALL SAMPLES RECEIVED FOR ANALYSIS BEEN STORED ON ICE? <br /> (SIGNATURE) 3/3 I AT 2 WILL SAMPLES REMAIN REFRIGERATED UNTIL ANALYZED? C V <br /> r <br /> , ZQ I <br /> (SIGNATURE) ISIGN TUREI 3 DID ANY SAMPLES RECEIVED FOR ANALYSIS HAVE HEAD SPACE? <br /> (SIGNATUREI {SIG EI 4 WERE SAMPL IN APPROPRIATE CONTAINERS AND PROPERLY PACKAGED? <br /> i I <br /> DATE <br /> (SIGNATURE) ISL URE) SIGNATURE TITLEp,\, <br /> 1 L�+ <br />