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' I i <br /> LAI N E 1ROGERS <br /> SAN.LOSE,CAU F QANIA95112.1105 CONDUCT ANALYSIS TO DETECT LAg SEQUOIA iDHS it <br /> FAX(406)573-7771 ALL ANALYSES MUST MEET SPECIFICATIONS AND DETECTION LIMITS <br /> TECH SERVICES INC PHONE(40 B)573-6555 SET BY CALIFORNIA DHS AND ' <br /> I <br /> ❑EPA ❑RWQCB REGION <br /> CHAIN OF CUSTODY El LIAnn <br /> �Ail CA � ❑OTHER � <br /> CLIENT w C� <br /> E nzva - Karen Petryna ? c 00 SPECIAL INS I�UCTIONS I <br /> SITE 341 East Main Street 4 w <br /> Send invoice to Equiva i <br /> 0 E-4 > as <br /> Ripon, CA 0 Q �/ <br /> P a c° W Incident # �� S� 77 <br /> IV fn 0C ca v ai w II <br /> � � <br /> MATRIX CONTAINERS a ► '� p b A Send report to Blaine Tech Services <br /> I <br /> 5C%10 x rq m Attl. Ann Pember <br /> SAMPLE I D �� ' c»� OTAL U ADD'L INF CONDITION STATUS CONDITION LAB SAMPLE# <br /> r Cor'';r m ►ri�F talc 1 <br /> xl <br /> II <br /> II <br /> S <br /> II , <br /> n <br /> II <br /> II =� <br /> II , II <br /> SAMPLING JDATE ITIME SAMPLING RESULTS NEEDED <br /> COMPLETED �, PERFORMED BY NO LATER THAN <br /> RELEASED BY 'V DATE TIME RECEIVED BY /. DQE TIME <br /> RELEASED BY JDATE TIME RECEIVED B II / DATE G� TIME <br /> RELEASED BY i DATE TIME RECEIVED BY I� JDATE <br /> ]TIME <br /> u I <br /> SHIPPED& DATE SENT TIME SENTj COOLER'# <br />