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_ an M M ❑ggJarvIlOve • an MWA 9W0- (4N"76-J• FA1W8) A308 M S <br /> � ,,QUOIA ANALYTICAL g,819 Striker Ave , 8 - Sacramento, CA 95834 - (916) 921-9600 • FAX (916) 921-00 <br /> ❑404 N Wiget Lane • Walnut Creek, CA 94598 • 925 988-9600 • FAX 925 988-9673 <br /> 1/ CHAIN OF CUSTODY ❑ 1455 McDowell Blvd North, Suite D • Petaluma, 94954 - (707) 7929865 • FAX (707) 792-0342 <br /> ❑ 1551 Industrial Road • San Carlos, CA 94070 - (650) 232-9600 • FAX (650) 232-9612 <br /> Company Name �"G f cSfar / I �r'1 ( . Protect R I ' 7 <br /> �►, I � eC <br /> Mailing Addressf) ra 1 Billing Address (if different) <br /> City State CA Zip Code 95 3.5 <br /> f e <br /> Telephone jbq _67C3_ j Fax# - 5-7q- PO # Payment Received ❑Yes ❑ No Q3 <br /> U <br /> Report To �� ,� E-Mail r 11 QC Data vel D (Standard) ❑ Level C ❑ Level B ❑ Level A <br /> Turnaround X10 - 15 Working Days ❑ 3 Working Days ❑2 -8 Hours Mandatory Sampler a <br /> Time ❑ 7 Working Days ❑ 2 Working Days ❑ Drinking Water ma <br /> El Working Days El Working Day ❑ Waste Water <br /> �4ther Q. 1 <br /> 5 <br /> Client Date/Time Matrix # of Cant Sequoia's aaye �i <br /> Sample t D Sampled Desc Cont Type Sample # p� �7 k i Comments <br /> V, ✓ IX r <br /> 2 k <br /> 2Alimc <br /> 0 <br /> 3 Cr <br /> 4 <br /> 0 <br /> 5 } <br /> 6 <br /> 7 <br /> 0 <br /> 8 ami <br /> CO <br /> 9 m <br /> 10 <br /> Relinquished By ��( Date ; Time %r w Received B - r Date } Time ; <br /> Relinquished By Date Time Received By Date Time <br /> Relinquished By Date Time Received By Date Time <br /> Were Samples Received in Good Condition9 ❑ Yes ❑ No Samples on Ice9 ❑ Yes�4_No Method of Shipment Page L_of <br />