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n_ bM IM M M i IM885s D Mo0PHill,'W500"408MW9600WAX IM 78 - IM <br /> E © 1455 McDowvd, Suite D • Petaluma, CA 94954 + (707) 792-1865 • FAX (7 2-0342 <br /> QUOIA ANALYTICAL ❑ 819 Striker Ave , Suite 8 + Sacramento, CA 95834• (916) 921-9600 + FAX (916) 921-0100 <br /> 0 CHAIN OF CUSTODY Cl 1551 Industrial Road • San Carlos, CA 94070 + (650) 232-9600 • FAX (650) 232-9612 <br /> © 404 N Wiget Lane + Walnut Creek, CA 94598 • (925) 988-9600 • FAX (925) 988-9673 <br /> Company Name b LOC- Project wykS iN 0 $ R%EA0hV 6 � fo cA <br /> Mailing Address Billing Address (if different) <br /> City State Zip Code <br /> Telephone Fax# PO # <br /> Report To P�v fswa E-mail Address QC Data Leve! 11 (standard) ❑ Level III ❑ Level IV <br /> Sampler � ` Date 1 Time Results Required Sequoia's Work Order# <br /> Turnaroun 10-15 Workin Days ID 72 Hours MANDATORY ANALYSES REQUESTED Please orovide method <br /> Time (Standard TAT) ❑ 48 Hours Q SDWA(Drinking Water) <br /> ❑ 7 Working Days ❑ 24 Hours Q CWA(Waste Water) <br /> ❑ 5 Working Days ❑ 2-8 Hours ❑ RCRA(Hazardo-ps V te) <br /> ❑ Other x� <br /> Client Date/Time Matrix #of Con�,a1 � as fi �' Comments/ <br /> Sample I D Sampled Sample# <br /> S4F escCont <br /> rt Temp(if required) <br /> i 1 M LO opqv t l At"' ,W, <br /> f�. <br /> 2 MW j (V 7 fV21 08q r w �- <br /> M <br /> 4f5 <br /> 1:6 ktV <br /> r <br /> 0 C0.43 <br /> SOP <br /> 7 sbo winSu'�4a <br /> ra <br /> 8 4 <br /> _c q <br /> ` 1Q 16 DS - rN°yaw <br /> Relinquished By Date 1 Time 41d� fp: <br /> Relinquished By Receive Date 1 Time <br /> Relinquished By Received By Date I Time 6-14-a <br /> Relinquished By Received By Date J Time <br /> Were Samples Received in Good Condition? ❑ Yes ❑ No Samples on Ice? ❑ Yes ❑ No Method of Shipment Page of <br /> White Sequoia Yellow Sequoia Pink Client <br />