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SEQUOIA ANALYTICAL O 680 Chesapeake Drive • Redwood City, CA 94063 • (415) 364-9600 FAX (415) 364-9233 <br /> `� CHAIN OF CUSTODY ❑ 819 West Striker Ave. • Sacramento, CA 95834 - (916) 921-9600 FAX (916) 921-0100 <br /> ❑ 1900 Bates Ave., Suite LM • Concord, CA 94520 • (510) 686-9600 FAX (510) 686-9689 <br /> Company Name: Project Name: <br /> Address: I Li 1 TG SJ Billing Address ( it different): <br /> COY , cziyc'-V-,.,ply State: �� Zip Code: cSf I( <br /> Telephone: 3 -39 1 FAX#: , ,S cwu-L P.O. #: q Sp 113 —3 <br /> Report To: t c 0'1-z✓J tv_ Sampler: OC Data: ❑ Level A(standard) ❑ Level B ❑ Level C ❑ Level D U <br /> Turnaround ArIO Working Days ❑ 3Workin9Day <br /> s ❑ 2 -8 Hours L) Drinking Water lAnalyses Re nested � <br /> Time: ❑ 7 Working Days ❑ 2 Working Days a <br /> ❑ Waste Water <br /> ❑ 5 Working Days ❑ 24 Hours ❑ Other <br /> Client Date/Time Matrix #ofCont. Sequoia's Q� <br /> Sample I.D. Sampled Desc. Cont. Type Sample# Comments <br /> 1. CIA -k- t-3' A131145 1'. - )C),190 T <br /> 0 <br /> 2. <br /> 3. 3 <br /> 0 <br /> 4. } <br /> 5. <br /> 6. <br /> 7. • <br /> m <br /> 0 <br /> 8. 'v <br /> a <br /> 9. <br /> r <br /> r <br /> 10. <br /> Relinquished By: w Date: 1//6/1 5 Time; ys Received By: Date: Time: <br /> Relinquished By: Date: Time: Received By: Date: Time: <br /> Relinquished By: Date: Time: Received By Lab: Date: Time: 4 <br /> Were Samples Received in Good Condition? U Yes U No Samples on Ice? U Yes U No Method of Shipment-s-,' Page_of <br />