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M M IM I♦ IM85 OW Dr Mo�HI1r,�503�08AW960PWAX R"78 <br /> 7n- <br /> EQUOIA ANALYTICAL ❑ 1455 McDow vd, Suite D + Petaluma, CA 94954 • (707)792-1865 + FAX (70 2-0342 <br /> 819 Striker Av , Suite 8 + Sacramento, CA 95834 + (916) 921-9600 + FAX (916) 9 1-0100 <br /> %F CHAIN OF CUSTODY ❑ 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 NameProject <br /> Mailing Address Billing Address (if different) <br /> City State Zip Code <br /> Telephone Fax# P O # <br /> Report To � ..-,�, E-mail Address QC Data Level II (standard) ❑ Level III ❑ Level IV <br /> Sampler �}. a Date I Time Results Required Sequoia's Work Order# <br /> Turnaround .` 10-15 Working Days ❑ 72 Hours MANDATORY ANALYSES REQUESTED Please provide method <br /> Time (Standard TAT) ❑ 48 Hours ❑ SDWA(Drinking Water) <br /> ❑ 7 Working Days ❑ 24 Hours ❑ CWA(Waste Water) <br /> ❑ 5 Working Days ❑ 2-8 Hours © RCRA(Hazardou��e <br /> Other "kwx <br /> Client Date 1 Time Matrix #of Cont .1 r a { Ti a s µ= g b1 Comments/ <br /> Sample I D Sampled Dese Cont Sample# Temp(If required <br /> 6 1 W-$ S7r u l a <br /> 2S (�4 G ro7.o 1V <br /> _a <br /> 3 � <br /> 4 <br /> F <br /> NW <br /> 5 1:)Z- to <br /> a , Un <br /> ff <br /> 7 r0Q e"A/PZ" <br /> F <br /> M <br /> 9 <br /> 10 <br /> Relinquished By <br /> Date/Time <br /> Relinquished By ReceiveDate/Time <br /> �` a Date 1 Time <br /> Relinquished By Received By Date 1 Time <br /> Relinquished By Received By Date 1 Time 4-�sZ o <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 />