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IZT7 <br /> OTX AM LITCAr ❑ 680 Resive DnMRed City, CA 9406 (650 -960 X {650 9233 <br /> ❑ 819 Striker Ave , Suite 8 • Sacramento, CA 95834 • (916) 921-9600 FAX (916) 921-0100 <br /> 1w CHAIN of CUSTODY ❑404 N Wiget Lane - Walnut Creek, CA 94598 - (510) 988-9600 FAX (510) 988-9673 <br /> Company Name Project Name r-' t " C <br /> Address Gv(" hr%Ly- Billing Address (if different) <br /> City t�jLi,+�r�ro State Zip Code <br /> Telephone 5 �z C f FAX # Z.� �_Z PO # <br /> t m <br /> Report To ^t'I r�'n J. t Sampler rc"A QC Data b1evel D (Standard) ❑ Level C ❑ Level B ❑ Level A v <br /> i Y <br /> Turnaround 5`10 Working Days :13 Working Days ❑2 - 8 Hours ❑ Dunking Water Analyses Requested <br /> CL <br /> Time ❑ 7 Working Days ❑2 Working Days ❑Waste Waters <br /> ❑ 5 Working Days ❑24 Hours ❑Other + \� <br /> Client Date/Time Matrix # of Cont Sequoia's ti� �3� <br /> Sample l D Sampled Desc Cont Type Sample # Comments <br /> 0 <br /> 2 Sfl --r'4- c1 ods! 4 ai <br /> To <br /> 4 it%J�-S(3�- p <br /> 5 1 Z.(S7' <br /> 6 r55 X <br /> 7 R`t$��39(1- z� 0 �t,a0 <br /> 0 <br /> k Cr <br /> e r�v��-S4tl- a.s.� ���� <br /> 0) <br /> U) <br /> 9 <br /> 10 <br /> Relinquished By `� _ �.-_ Date q Time t ; t Received By Date Time <br /> I <br /> Relinquished By Date Time Received By Date Time <br /> Relinquished By Date Time Received By Lab Date Time <br /> Were Samples Received in Good Condition? ❑Yes ❑ No Samples on Ice? ❑Yes ❑ No Method of Shipment Page of <br />