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1 U01A ANALYTICAL ❑ sao cne��p��• R�City,CA � • ������s4-seoa FAX�a �s� - <br /> 0) CD_ ❑ 818 W s er Ave -memento.CA 96834 -(916)921-9600,-FAX(91&2i-0f <br /> VJAIN OF CUSTODY ❑ 1608 Bates Ave..Suite LM•Coiroord, CA 94529-(510)6WO600 FAX(510)686-961p-,"- <br /> OD ` <br /> F7TOJephone: <br /> y Name. v f� ttr4 r ,,s Project Name VAt c i r Ts 21 • <br /> Q BBing Address it different} <br /> cc <br /> hrf ,��ro v Pw State G�} Zip Code: �s' Z <br /> ,Za - o �7 3GZ FAX#: S +s- PO iR:IL <br /> v o. ✓r c, t � .y Sam ler: QG Data• ❑ Level A(sic } ❑Lwei B ❑ level C 13 i.evel D i <br /> x <br /> Turnaround % 10 Working Days ❑3 Working Days ❑ 2-8 Hours ❑ Drinkirg Water es ested a <br /> n <br /> Tlane: ❑ ?Wodung Days U 2 Working Days D Waste Water <br /> ❑5 Working Days ❑24 Hours ❑ Other <br /> +r <br /> Gent Dataf ne Matrix #of Corm. Se ola% <br /> Sample i D Sampled Dose. Cord Type Sample# �(a Comrnertt`s " <br /> y <br /> 3Q I Ji I AWL <br /> Ln <br /> 2. 4P_ <br /> � »x <br /> C,r''� z •nv'S s rk x <br /> 4. <br /> YyJY '..i.NTl? A.•.{%rvimfV..+t x•r v+]it43.r x1SlA SJ &` <br /> CE <br /> !Vvxxi YvCe�W ` f m <br /> E.A.P 2f <br /> V <br /> ' <br /> 4, iwsS f ` <br /> I � ,.Yiv -vf�Y 3���� ia�yf,i�t~ Y�� pa�3• jAJT• �C i a . • i <br /> Ah y <br /> �y4y�( w <br /> \Z�Qf.[ARFF 4•kF J xx,Qxf%�\ y' �x..4 � .? Y�3d+ <br /> 7. 2�' <br /> �''�rti�r a 5iPf i�7v CD <br /> R 3 xx <br /> Q`. : ;! <br /> RelvwlshedBy. Date Time.-Z7c v Received By: Date• we <br /> Relinquished By Date. Tme: Received By: Ditto: iiia:R K. <br /> Reli (shed Oahe Timceived <br /> e: Re1. . Q � i <br /> Were Sar les Receiued In Good Condition?4 Yes C1 hb Samples on Ice? 0 Yes U No Method of Shipruerrt �^ �, r i , PrIMM„.of,,"l-, <br />