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BLAINE <br /> 1880 ROG NUE - _. . - <br /> ' <br /> SAN JOSE,CALIFORNIA 05112-95112-1105 CONDUCT ANALYSIS TO DETECT ILAB SEQUOIA IDHS R <br /> FAX(408)573.7771 ALL ANALYSES MUST MEET SPECIFICATIONS AND DETECTION LIMITS <br /> TECH SERVICES INC PHONE(408)573-0555 SET BY CALIFORNIA DHS AND <br /> ❑EPA ' ❑RWOCB REGION <br /> CHAIN OF CUSTODY ❑LIA <br /> J�o � o OTHER <br /> CLIENT <br /> E uiva - Karen Petryna z CD 00 SPECIAL INSTRUCTIONS <br /> SITE 4 p II <br /> 343 East Main Street p Send invoice to Equiva <br /> v H � <br /> Ripon, CA w w <br /> a o r4 A Incident # �/� 995�?7y <br /> w 00 In <br /> v m II <br /> T Qj <br /> MATRIX CONTAINERS CL I w W � Q Send report to Blaine Tech Services <br /> -joo <br /> C'4 o w w H ": Jim, Ann Pember <br /> SAlv1PLE I 0 dcJ I< r 4AILQ " " TOTAL v ADD L INFORMATION STATUS CONDITION LAB SAMPLE # <br /> b�1U'.'- �i f ��f'9 II [{� �`� 5 carrGr►++ 1f;ItS +SPI r✓ <br /> b S'3 <br /> Ct <br /> II <br /> II <br /> II S 'r <br /> it <br /> d <br /> i <br /> SAMPLING DATE ITIME SAMPLING RESULTS NEEDED <br /> \ COMPLETED � ,��5 NO LATER TH <br /> PERFORMED BY II <br /> AN <br /> 7-I�-�`� I l l u 1,�111�! <br /> RELEASED BY JDATE I TIME RECEIVED I DATE ITIME <br /> i�ELEASED 8Y r, JOATE TIME RECEIVED BY II ATE TIME <br /> SED BY 16ATE 1TIME RECEIVED BY II ri DAT a� TIME <br /> A DATE SENT TIME.SENT CGOLEA# <br />