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Ell 680 Chesape k8'Grn+e*Redwood City, CA 94063 • (650) 364-9600 FAX (650) 364-93 <br /> il) OUOIA ANALYTICAL Q 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 • (925) 988-9600 FAX (925) 988-9673 <br /> ❑ 1455 McDowell Blvd North, Suite D • Petaluma, CA 94954 • (707) 792-1865 FAX (707) 792-0342 <br /> Company NameProject Name � , <br /> SSA a e S �v� t a �a v-► ��-�.�{� 1 ocsc3 � <br /> Mailing Address M"I Uort-%,. -%\%., N v e c-"J b Billing Address (if different) <br /> City Mode%vo State Col. Zip Code 9:5351 <br /> Telephone -Loci r-7q . 2� FAX # 201-r571-,? z,75- PO # <br /> Report To Nu t— 1 Sampler A t e QC Data Jefleovel D (Standard) ❑ Level C ❑ Level B U Level A U <br /> Turnaround P4 Working Days ❑3 Working Days Q 2 -8 Hours Q Drinking Water Analyses Requested <br /> Time ❑ 7 Working Days ❑2 Working Days Q Waste Water <br /> 0 5 Working Days 1124 Hours vE(Otherir'0 <br /> Client Date/Time Matrix # of Cont Sequoia's ,+ <br /> Sample I D Sampled Desc Cont Type Sample # Q� Comments <br /> + ow+ <br /> 1 <br /> 0 <br /> 2 Mw- Z onn 0 3 � <br /> M W <br /> Iwo <br /> t� 0 <br /> 0 <br /> } <br /> 4 <br /> 5 <br /> 6 <br /> 7 <br /> 0 <br /> cr <br /> 8 cn <br /> 9 t <br /> 10 <br /> Relinquished By , ..w� Date 6 Time Received By _fes t Date/o A, S� Time <br /> Relinquished By Date Time Received By Date Time <br /> Relinquished By Date TimeReceived By Lab Date Time <br /> Were Samples deceived in Good Condition? ❑Yes Q No Samples on Ices des 0 No Method of Shipment 0AWr _ Page 1 of A_ <br />