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i iu "'arv'�I ' a`�"�ti� r r� ) �� V <br /> UOIA ANALYTICAL ° MC6°'�"� "ate P� ' c sa 7 s5 �c �7 <br /> 819 Sinker Ave , $ Sacramento, CA 95834 (916)921-9600 FAX (916) OW <br /> CHAIN OF CUSTODY 131551 Industrial Road • San Carlos, CA 94070 • (650)232-9600 • FAX (650) 232-9612 <br /> ❑ 404 N Wget Lane • Walnut Creels, CA 94598 • (925)988-9600 • FAX (925) 988-9673 �j <br /> Company Name o Project 16103600 <br /> Mailing Address (a of KQ T ✓ Billing Address ( different) <br /> City y /`t,,•.,c 7-a State Zip Code <br /> Telephone /C� Fax# PO # <br /> Report To V l Grp E-mail Address QC Data evel 11 (standard) ❑ Level III ❑ Level IV <br /> Sampler ,,t- W r1 Date 1 Time Results Required Sequoia's Work Order# <br /> Turnaround 'A- 10-15 Working Da ❑ 72 Hours MANDATORY' S D ase roV d method) <br /> Time (Standard TAT) ❑ 48 Hours ❑ SDWA(Drinking Water) <br /> ❑ 7 Working Days ❑ 24 Hours ❑ CWA(wastewater) <br /> ❑ 5 Working Days ❑ 2-8 Hours ❑ RCRA(Hawnrdo \ <br /> �Oiher � 'r <br /> t` ` t 3€ ' Comments/ <br /> Client Date 1 Time Matrix #of Con i v �^ a s <br /> Sample I D Sampled Dese Cant , x ,q Sample# 1 u, 3" Temp If required) <br /> F" A, Y, <br /> "'Ank <br /> 3 MINTY , <br /> 4 , 6 k "t <br /> =Klvlzet " <br /> 5 r i 1 J 1r } <br /> b' e s ai aa cSlx• ` i. <br /> �l ery u, � � <br /> 8 Mk Sr Y i P ti `y <br /> 1 1 L <br /> 9 <br /> 10 <br /> Relinquished B - 1`1 211 " ' Date!Time l u <br /> Relinquished By Receive Date I Time <br /> Relinquished B • Received By Date 1 Time <br /> Relinquished By Received By Date 1 Time <br /> Were Samples Received in Good Condition? ❑ Yes ❑ No Samples on Ice? ❑ Yes ❑ No Method of Shipment Page of <br /> White Sequoia Yellow Sequoia Pink,Client <br />