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80 ChesaT!ce Drive <br /> QUOIA ANALYTICAL • Redwood City, CA 94063• (650) 364-9600 FAX (650) <br /> ` :. <br /> ❑ 819 Striker;5 Suite 8 • Sacramento, CA 95834• (916) 921-9600 FAX (916) 9"100 <br /> 1/ CHAIN OF CUSTODY ❑404 N.Wiget Lane • Walnut Creek, CA 94598 • (510) 988-9600 FAX (510) 988-9673 <br /> Company Name: AX ke_s C- Project Name:�Gt4o,,% <br /> Address: !Zbp Gvesulci Billing Address (if different): <br /> City: MoaJr.0 State: Zip Code:q_S ZS I <br /> Telephone:249--5 $-zzz i FAX#: _Z Z Z5- P.O. #: <br /> Report To: Sampler:Aks_.�, .�to rcs OC Data: evel D (Standard) ❑ Level C ElLev6l B 13Level A U <br /> 1 <br /> x <br /> Turnaround GKO Working Days ❑3 Working Days ❑2-8 Hours ❑Drinking Water Analyses Requested � <br /> 4 <br /> Time: ❑ 7 Working Days ❑2 Working Days E❑Waste Water <br /> ❑ 5 Working Days El 24 Hours tether <br /> Client Date/Time Matrix # of Cont. Sequoia's 1 Comments <br /> Sample I.D. Sampled Desc. Cont. Type Sample # <br /> 1. tAw-3 0045cM100 VJ 2. �*"s r <br /> Q <br /> 2. MvJ- (o 050 �- [� �/ m <br /> 3. <br /> r41 <br /> si g 4�. <br /> 4. <br /> 5. t <br /> t <br /> V111 <br /> 7. <br /> B. . <br /> 1 ' <br /> rt(+ <br /> 9. 2 <br /> J <br /> 10. <br /> Relinquished By: �,,4sz-x� .Date: Time: Received By: Date:/ Time: <br /> Relinquished By: Date: Time: Received By: Date: Time: <br /> Relinquished By: Date: Time: Received By Lab: Date:L17�B��B Time:[ d <br /> Were Samples Received in Good Condition? /ErYes 0 No Samples on Ice? Byes 0 No Method of Shipment 04D rr�lee Page 1 of � <br />