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EI�PT � r <br /> �1 tf� � <br /> D SERVICES INCORPORATED C H A I N O !; CUSTODY <br /> �r <br /> 401 Stanwell DrIVe,Suite 400 <br /> Concord,Caldornla 94520 <br /> Tel (510)6o2-51 0(), Fax.(510)689-1918 <br /> SAMPLER UNOCAL 7 ` ANALYSES REQUESTED <br /> SIS # �v CITY �'UL 1&-) ANALYSES <br /> TURN AAOUN!? 7JMIr: <br /> VARTKES TASHDJIAN R �/ W <br /> ADDRESS. q 7 6 7Z hCzG 1 A � 0 a <br /> WITNESSING AGENCY 1 04 1 N O <br /> SAMPLING a H a O Q REMARKS <br /> SAMPLE ID NO DATE TIME WATER GRAB COMP NO OF CONT LOCATION H A H A H Go <br /> 014548 <br /> X Y x 01 549 <br /> 601 550 <br /> DATE/TIME THE FOLLOWING MUST B COMPLETED BY THE LABORATORY ACCEPTING SAMPLES FOR ANALYSIS <br /> RELINQUISHED 8Y DATE/TIME RECEIVED (3Y <br /> �lg 1 HAVE ALL SAMPLES RECEIV LYSIS BEEN STORED ON ICE? ./ <br /> v <br /> �r ISI EJ ��; <br /> �Z-c) <br /> SAMPLES REMAIN REFRIGERATED UNTIL ANALYZED? <br /> [S!G T 1 <br /> (SIGNATURE) <br /> =TURE) <br /> 3 DID ANY SAMPLES RECEIVE[]FOR ANALYSIS HAVE HEAD SPACE? � <br /> {SIGNATURE) <br /> 4 WERE SAMPLES W APPROPRIATE CONTAINERS AND PROPERLY PACKAGED? <br /> {SIGNATURE) SIGNATURE TITLE.. 4vAygs1 DATE /lZ� <br /> (SIGNATURE) <br /> Yots All water containers to be sampled for TPHGIBTEX, 8010& 8240 are preserved with HCL All water containers to be sampled for Lead or Metals are preserved with HNO3 All other Containers are <br /> unpreserved __ <br />