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! • C/ Dot, () r • <br /> Sequoia <br /> DHS# <br /> 1680 ROGERS AVENUE CONDUCT ANALYSIS TO DETECT LAB Se q <br /> BLAINE SAN.FOSE,CALIFORNIA 95112-1105 ALL ANALYSES MUST MEET SPECIFICATIONS AND DETECTION <br /> FAX(408)573-7771 LIMITS SET BY CALIFORNIA DNS AND <br /> TECH SERVICES,INC PHONE{408) 573 0555 ❑ EPA ❑ RWQCB REGION <br /> �] LIA <br /> ❑ OTHER <br /> [CHAIN OF y <n/ Q, <br /> SPECIAL INSTRUCTIONS <br /> LIENT QE uiva - Karen Pet na <br /> Z Sell(I ,,voice to Equiva <br /> ITE ° <br /> 440 W Charter Way x <br /> Incident # 88870583 <br /> Stockton, CA H `0 � <br /> 00 00 a) ; Send report to Blaine Tech Services, Inc <br /> MATRIX CONTAINERS ° 11 W w b ATTN Ami Pember <br /> ax x <br /> 11 a H H <br /> n '� ADD L INFORMATION STATUS CONDITION LAB SAMPLE# <br /> SAMPLE I D DATE TIME TOTAL. U E- <br /> /�G� 1 ig t3 z r.✓ y <br /> Ll <br /> Gv /01/ <br /> - � Al f /� 2-,L- RESULTS NEEDED <br /> SAMPLING DATE TIME SAMPLING NO LATER THAN <br /> COMPLETED S`� PERFORMED BY C <br /> / TIME <br /> RELEASED 8Y D�� TIME n ,.��RECEIVEiJ� <br /> /I C/ --�� <br /> DATE TIME <br /> RELEASED BY C DAT TIME �RECEiVED BY J/ �� f� �� IM <br /> J C DATE TIME <br /> RELEASED BY ATE TIME RECEIVED BY <br /> DATE SENT TIME SENT COOLER# <br /> HIPPED VIA <br />