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1 8885 Jarvis Drive • MAve , S �n Hill, CA 95037 • (408) 776-9600 • FAX (408) 782-6308 <br /> SIaIA ANALYTICAL iU 404 NSir <br /> yviret Lane- Walnr t Creek, CA 459$83925) 988 960016) 921 6FAX 900 FAX5) 988 967.3 Y <br /> l_l /� IAI !1e CUSTODY <br /> U 1455 McDowell Blvd North Suite D • Petaluma, CA 94954 • (707) 792-IB65 FAX (707) 792 0342 <br /> qW CHAIN V V 1 CUS 1 1 U 1551 Industrial Road • San Carlos, CA 94070 • (650) 232-9600 FAX (650) 232-9612 <br /> Company Name � �SS(�C �,QgS T�,� Protect Name �� <br /> Mailing Addr�ss 1 t 4-j Lon" Billing Andress (if different) <br /> City M 0A, svo State Zip Code <br /> Telephone 2t)Q -Sg = PO <br /> ' <br /> T <br /> Report To �� �� Sampler &\ e�k f re-S OC Data Kevei D (Standard) U Level C U Level B U Level A v <br /> Turnaround 4�jQ0 Working Day8 ❑3 Working Days U 2 8 Hours U Drinking Water Analyses Requested <br /> Time J I Working Days ❑2 Working Days t]Wasie Water <br /> J 5 Working Days Q 24 Hours V.Qther4VI <br /> Clkei,i Date/Time Matrix # of Cont Sequoia's V Comments <br /> Samplc l D Sampled Desc Cant Type Sample 4 <br /> LJ 0 ►M I <br /> 1 l - <br /> — o <br /> 7 <br /> 3 Mw <br /> 4 <br /> 7 Lo <br /> O <br /> 8 --- <br /> 10 <br /> Retingursl ad By � Date / Time Received By � �i� c�.,� , Date ����1 Firne <br /> Relingfu5l ad BY Dale �Jl�L Time {)[� Received By Date 9/c Time <br /> j ReluiquisI ,.d By Date Time Received By Lala n Date 1 irroe <br /> l�1rrF S,am ,1 u< mv, diii (,nod row ifmn? Yes L] Nn S„Ijjples nn Ire Yrs I i Nn Method of gNDi Pni `f'� 7r i n Y" i' I <br />