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BLAINE 1880ROBER5 AVENUE <br /> SAN JOSE,CALIFORNIA 8 -1105 CONDUCT ANALYSIS TO DETECT ILAB SEQUOIA IDHS# <br /> TECH SERVICES PHONENE(408)573-0555 <br /> FAX(408))573 573-7771 ALL ANALYSES MUST MEET SPECIFICATIONS AND DETECTION LIMITS <br /> SET BY CALIFORNIA DHS AND <br /> CHAIN OF CUSTODY/ ❑EPA ❑RWOCB REGION <br /> O 7 I I ❑LIA <br /> O ❑OTHER <br /> CLIENT w O <br /> E uiva - Karen Petryna z O SPECIAL INSTRUCTIONS <br /> SITE305 S. Hutchins St. z x : p <br /> 0 w Send invoice to Equiva <br /> PQ o p a Q <br /> Lod-, CA a N w Incident # 910 75Z75 <br /> m m v w w <br /> m <br /> � on <br /> MATRIX CONTAINERS w w v q Send report to Elaine Tech Services <br /> ON •= Attn: Ann Pember <br /> ° O El P ,y d <br /> SAMPLE I.D. -fmoa TOTAL 0 w ADD'L INFORMATION STATUS CONDITION LAB SAMPLE# <br /> w <br /> M w- proVj 1V <br /> SAMPLING IPATE ITWE SAMPLINGr RESULTS NEEDED <br /> COMPLETED d rlO PERFORMED BY ' NO LATER THAN <br /> RELEASff B. <br /> CAT I TIME RECEIVED - - DATE ITWFE <br /> oU 4)7 /l � Y � 4Z5/ <br /> RELEASE6 BY JDATE TIME �REC BY DAT/ TIME <br /> RELEASED BY JDATE ITIME RECEIVED BY JDATE TIME <br /> SHIPPED VIA DATE SENT TIME SENT COOLER# <br />