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MUM AT L'MC" �8o �a�rivelMdARty, dM0634"0) 30W00 M(652W <br /> !'1 J 819 Striker Ave , Suite 8 • Sacramento, CA 95834 • (916) 921-9600 FAX (916)79V2 - 00 <br /> CHAIN OF CUSTODY ❑ 404 N WEget Lane •Walnut Creek, CA 94598 • (925) 988-9600 FAX (925) 988-9673 <br /> 1455 McDowell Blvd North, Suite D • Petaluma, CA 94954 • (707) 792-1865 FAX (707) 792-0342 <br /> Company Name /4T[ Project Name t VµV y j jr <br /> Mailing Address r )C V Billing Address (if different) <br /> City AQ t1j,' State CSS Zip Code <br /> Telephone Z. 7 '! - Z L r FAX # LC�7 S y _ Z� PO # <br /> Report To . �� � L,� L Sampler �c t1 L„V-� OC Data �evel D (Standard) ❑ Level C ❑ Level B ❑ Level A U <br /> z 61 Y <br /> Turnaround 110 Working Days ❑3 Working Days ❑2 - 8 Hours D Drinking Water Analyses Requested <br /> Time ❑ 7 Working Days ❑2 Working Days Vother aste Water {� <br /> U 5 Working Days U 24 Hours �` 1 <br /> C�� <br /> Client Date/Time Matrix # of Cont Sequoia's may, Comments <br /> Sample I D Sampled Desc Cont Type Sample # � v <br /> 35 r, <br /> ro <br /> 0 <br /> z aro �� t f <br /> 3 0 <br /> 4 <br /> 5 <br /> 6 <br /> �n <br /> 7 Q <br /> a� <br /> 8 m <br /> X00 CICS DYS LSIN ACT❑ NOT NTA'T <br /> 9 COPIER T R T <br /> 10 <br /> Relinquished By 03051q Time a Received By -fr j Date �5 Time I 7-S <br /> Relinquished Bye C, L Date Time t z Received By Date Time <br /> Relinquished By <br /> Date ;�� Time Received By Lab �G ?�; rr Da#e /,� Time 1,7-e,d <br /> Were Samples Received in Good Condition? ❑&a 0 No Samples on Ice? [ Yes ❑ No Method of Shipment bVN1VMtK Page Z of _ <br />