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�WtiriAerWee, <br /> r • an Ha 4 io rn o Ju�UOiA ANALYTICAL en , A 9 (91 ,-9 Ax 92� r � <br /> ❑ 404 N Wiget Lan alnut Creek, CA 94598 • (925) 988-9600 FAX (925) 988-9673 <br /> CHAIN OF CUSTODY ❑ 1455 McDowell Blvd North, Suite D • Petaluma, CA 94954 • (707) 792-1865 FAX (707) 792-0342 <br /> ❑ 1551 Industrial Road • San Carlos, CA 94070 • (650) 232-9600 FAX (650) 232-9612 <br /> lCompanyPro ect Name Name !��G ��) S 1 � I � t` �, -�- �1 r - <br /> 1 <br /> # Mailing Address J Billing Address (if different) <br /> 0 <br /> City 1�� <� State Zip Code L c- <br /> Tele hone <br /> FAX # PO # <br /> Report To t 1 V� Sampled QC Data �t-Level D (Standard) EllLevel C © Level B Ell Level A U <br /> Turnaround P�Q Working Days ❑3 Working Days ❑2 - 8 Hours ❑Drinking Water \ h A n a i y s e s -e—dl C <br /> Time ❑ 7 Working Days ❑2 Working Days ❑Waste Water <br /> ❑ 5 Working Days ❑24 Hours 9,Qther <br /> Client Date/Time Matrix # of Cont Sequoia's Comments <br /> Sample I D Sampled Desc Gant Type Sample # � k <br /> 1 <br /> 121901 A i r — a <br /> Cf! <br /> S <br /> 3 <br /> r <br /> 4 <br /> 5 <br /> 6 <br /> Lo <br /> 7 p <br /> Cr <br /> 8 to <br /> Cn <br /> i <br /> 9 7� <br /> 7 <br /> 10 <br /> Relinquished Byi2ate /Z/gay 1 Time Received By Date to Time <br /> Relinquished By Date Time Received By Date Time <br /> Relinquished By Date Time Received By Lab Date Time <br /> Were Samples Received in Good Condition? ❑Yes 0 No Samples on Ice? ❑Yes L144Q Method of Shipment `~ Page I of <br />