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1♦ r [� Chaeak ei• Mood=CA=3 • ( 364OW F�50) ��_ _ <br /> UOIA ANALYTICAL 0 404 NtrWrget Lan WgInut Creek, CA 9458'@ Sacramento, CA 8 (92) 988-9600 600 FAX (916) 9121-0 <br /> FAX (925) 988-9673 <br /> wo CHAIN OF CUSTODY ❑ 1455 McDowell Blvd Nnrth, Suite D Petaluma, CA 94954 (707) 792-1865 FAX (707) 792-0342 <br /> 0 1551 Industrial Road • San Carlos, CA 94070 • (650) 232-9600 FAX (650) 232-9612 <br /> Company Name A� S Stat. it1 }� C Protect Name F-cl JV^' A ,P <br /> Mailing Address l3 vtt Billing Address (if different) <br /> City M' J�vj State Zip Code 7530 <br /> Telephone �,i� FAX # PO # a <br /> Report To Sampler +;� r ',�..� QC Data )I'lk-Level It (Standard) ❑ Chromatograms Q Level 111 U Level IV v <br /> Turnaround -Standard U 7 Working Days U 2 Working Days 0 Drinking Water Analyses Requested <br /> CL <br /> Time 10-15 U 5 Working Days U 1 Working Day 0 Waste Water <br /> Working Days <br /> U 3 Working Days U ASAP VOther <br /> Client Date/Time Matrix # of Cont Sequoia's {� Comments <br /> Sample I D Sampled Desc Cont Type Sample # <br /> f 4 1131-115 VTV <br /> n <br /> 73 <br /> 3 <br /> a <br /> r <br /> 4 <br /> 5 <br /> 6 <br /> ro <br /> 7 0 <br /> o- <br /> M <br /> 8 � <br /> m <br /> 9 L <br /> 10 AA <br /> Relinquished By � W �G�. l t--' Date ' / Time Received By r ���__- Date Time <br /> Relinquished By , Date rcTime Received By Date Time <br /> Relinquished By Date Time Received By Lab Date Time <br /> Were Samples Received in Good Condition2 U Yes U No Samples on Ice9 0 Yes U No Method of Shipment Page _of <br />