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r 80 Chesap Drive• Redwood City, CA 94063• (650) 364-9600 FAX (650) ` 233 <br /> i: :QUOIA ANALYTICAL <br /> ❑ 819 Striker Ave., Suite 8 • Sacramento, CA 95834• (916) 921-9600 FAX (916) 92 - 100 <br /> ICHAIN OF CUSTODY ❑404 N.Wiget Lane • Walnut Creek, CA 94598 • (510) 988-9600 FAX (510) 988-9673 <br /> Company Name: �1- i S`-CG' s. 1nC, Project Name:m ,�Am, ST .oao <br /> Address: j Billing Address (if different): <br /> City: Q � .� State: zip Code: e s <br /> Telephone: _ - FAX-#:x_579-zzzT- P.O. #: <br /> Report To: Sampler: �td res OC Dar;,:' - -evei D (Standard) El Leve l C ❑ Level B El A v <br /> Turnaround 4 Working Days ❑ Working Days O 2-8 Hours ❑ Drinking Water Analyses Requested <br /> I <br /> Time: ❑ 7 Working Days ❑2 Working.Days 0 Waste Water <br /> ❑ 5 Working Days ❑24 Hours Cotner <br /> Client Date/Time Matrix # of Cont. Sequoia's Comments <br /> Sample I.D. Sampled Desc. Cont. Type Sample # <br /> 1 0054 Otoo .s yq <br /> 2. M - l cSU ✓ Cr <br /> CO <br /> 4 s ° ,z3 <br /> LWA 1 0! i4 <br /> 5. <br /> 6. ,ice <br /> ' U t . <br /> 7. <br /> 8. <br /> O <br /> 9. <br /> 10. <br /> Relinquished By: , Date: Time: Received Date:/1' c Time:. <br /> Relinquished By: Date: Time: Received By: Date: Time: <br /> Relinquished By: Date: Time: Received By Lab: Date: Time: <br /> f Samples am les Received in Good Condition? ❑Yes ❑ No Samples on Ice? OYes ❑ No Method of Shipment it <br /> r P P P �t7f +'t Page_o <br />