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❑ 885 Jarvis Drive • organ Hill, CA 95037 • (408) 776-9600 • FAX (408) 782-6308 <br /> IDISQUOIA ANALYTICAL _119919 Striker Ave.,ie 8 • Sacramento, CA 95834 • (916) 921-9600 FAX (916) 921-015 <br /> Q 404 N.Wiget Lane •Walnut Creek, CA 94598• (925) 988-9600 FAX (925) 988-9673 <br /> CHAIN OF CUSTODY ❑ 1455 McDowell Blvd. North, Suite D • Petaluma, CA 94954 o (707) 792-1865 FAX (707) 792-0342 __ <br /> ❑ 1551 Industrial Road • San Carlos, CA 94070 • (650) 232-9600 FAX (650) 232-9612 <br /> r <br /> Company Name:Al-( _ yr <br /> Project Name:4 S �pQ Z <br /> Mailing Address: jH7 ���� a�i f Billing Address (if different): <br /> City:1k S 0 State: Zip Code:C <br /> y . <br /> Telephone:2 - _57c2- <br /> _Z.1 FAX #: Z01-579--.-ZZZS P.O. #: m <br /> Report To: /i'JIYI r Sampler: � ,� S QC Data: Level D (Standard) ❑ Level C ❑ Level B ❑ Level A U <br /> Y <br /> Turnaround rffi()Working Days ❑3 Working Days ❑2 -8 Hours Cl Drinking Water `�4. <br /> Analyses Requested � <br /> Time: ❑ 7 Working {lays ❑2 Working Days ❑Waste Water <br /> ❑ 5 Working Days ❑24 Hours )Othe(�1A1 ��0 �► <br /> Client Date/Time Matrix # of Cont. Sequoia's ��'�, �QQ` <br /> Comments <br /> Sample I.D. Sampled Desc. Cont. Type Sample # . <br /> 4 w. <br /> 1 U�" 1 �(nbSbO 103 S bG9�{-b) V o <br /> 2. <br /> 3. o <br /> 4• <br /> 5. <br /> 6. <br /> 7. o <br /> aD <br /> 8. ;�- .. rn <br /> a� <br /> 9. <br /> ` 10. <br /> Relinquished By: AJ(_A , � � Date: Time: Received By: Dater — Time: ())'U io <br /> Relinquished 8 �- Date: Time: Received B ,/;' f - - Date;Ae� C-t.) Time: C-,42 a <br /> Relinquished By: Date: Time: Received By Lab: Date: Time: <br /> Were Samples Received in .Good Condition? Utes U No Samples on Ice? SJ.Yes U No Method of Shipment_._ �_ __ Page _)of�__ <br />