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QUOIA ANALYTICAL 60680 Che ke Drive• Redwood City, CA 94063 • (650) 364-9600 FAX (65 -9233 <br /> ,:D* ❑ 819 Striker Ave , Suite 8•Sacramento, CA 95834 • (916) 921-9600 FAX (916)0100 <br /> 4W CHAIN OF CUSTODY ❑404 N Wiget Lane• Walnut Creek, CA 94598• (510) 988-9600 FAX (510) 988-9673 - <br /> Company Name 1��CQS _ Project Name aty,K� ca g�. <br /> Address 2-&0 �. ��13 �, Billing Address (if different) <br /> City ES State Zip Code 953-51 <br /> Telephone "-:577 _ ZZFAX #T17-57V-Z7Z--V FO # <br /> a� <br /> Report To ��v.f y, Sampler,4 L" �C-10 re S QC Data Ood Level D (Standard) ❑ Level C ❑ Level B ❑ Level A U <br /> �c <br /> Turnaround .EKG Working Days ❑3 Working Days ❑2-8 Hours ❑ Drinking Water 4 Analyses Requested <br /> ii <br /> Time ❑ 7 Working Days ❑2 Working Days ❑Waste Water <br /> ❑ 5 Working Days ❑24 Hours Other �� <br /> Client Date/Time Matrix #of Cont Sequoia's `� Zq r <br /> Comments <br /> Sample I D Sampled Desc Cont Type Sample # •n <br /> La In <br /> (� <br /> 'V?*V1 <br /> 1 IN <br /> 7 LY I I I I i 1K H <br /> 9 r <br /> 10 <br /> / Afflkl <br /> 5 <br /> Relinquished By ;41( 1. 41 <br /> G � Date Z& Time/ Received�y" O- ,� Dateb&Zbitt Time 1; - <br /> Relinquished By Date Time Received By Date Time <br /> Relinquished By Date Time Received By Lab Date Time <br /> Were Samp6es Received in Good Condition? ❑Yes 0 No Samples on Ice? Yes ❑No Method of Shipment /Vow counPage of <br />