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7acrarne7o, <br /> � �QUOIA ANALYTICAL � 819 W lriker Ave - CA 95834 - (916) 921-9600 FAX �} 921 0100 <br /> CHAIN o I= CUSTODY /EJ 660 Chesapeake Drive - Redwood City, CA 94063 • (415) 364 9600 FAX(415) 364 9233 <br /> LJ 1900 Bates Ave , Suite I_M - Concord, CA 94520 - (510) 686-9600 FAX (510) 686-968r- <br /> Company <br /> 86-968rCompany Name ['c, Project Name X o <br /> Address �,,��� �t , ' xr/�. Billing Address ( d different) — <br /> 71 <br /> Cdy State LZip CodeTelephone ">64 M2 - Zr��3 __— _ _ FAX # 7�C i 5C� P O # -� <br /> Re rt To CdUt G�s�lw�`_ Sarn�ier �i�✓_ r �11�r_ 1�— <br /> Turrtarot►nd Time [..) 10 VLrniHing Day- f_j 3 Worluii Da � <br /> 9 Ys 2 t3 !itlow-,,., AnalYseS Re nested <br /> C) V`lnit(r►1r1 kly5 U2 Workirui t�,�y� �.�---�- --. <br /> ki 'y <br /> C1 5 Woil,iny Da wc24 Hours <br /> Client _ Rete/liim, k1atnx- # of �('oiit SVqunias� 7 r ISU/• 1, ( �� �• ' �.� <br /> Sample I D _ Satrq>lrrl f)ecc Ypr_ Sample # /`4 +a�� �• i - l- /� Comments <br /> 2 s P �__ _ ----- - - --- — -- -- --- -- - - - u -- - _ - r i n <br /> 4 ' <br /> 5 <br /> 6 <br /> 7 T <br /> 8 Q <br /> 9 - _ ---- - --_ - ---- -- <br /> 10 <br /> Relinquished By 4L4 Date , r Time /c 5 Received By r ��- i_ Date "Time <br /> Relinquished By -�� �j'll Date � � j �Tune � 1 Received By( k 1 )f V1 h If 4 11 Date"111 ;), ime <br /> Relin cashed By I Date ITirne Received B Lab Date Time <br /> Were Samples Received in Good Condition? U Yes U No Samples on Ice? U Yes U No Method o1 Shiprnerd_ 11 Page �_of <br /> i <br />