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w 85 IM DrM04Wl11,M5030W08AW960P0AX R"78 r r� <br /> EQUOIA ANALYTICAL El1455 McDow vd, Suite D • Petaluma, CA 94954 • (707) 792-1865 + FAX (7 2-0342 <br /> _n_ 819 Striker Av , Suite 8 • Sacramento, CA 95834 + (916) 921-9600 + FAX (916) 921-0100 <br /> No D_HAIN 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 Name , L 3A, c Protect s rh S r,� <br /> Mailing Address Billing Address (if different) <br /> City State Zip Code <br /> Telephone Fax# PO # <br /> Report To D -,.a r,,,mL k r E-mail Address QC Data 0 Level It {standard) ❑ Level III ❑ Level IV <br /> FSampler fl,�,._, , �, Date 1 Time Results Required Sequoia's Work Order# <br /> Turnaround 10-15 Working Days ❑ 72 Hours MANDATORY ANALYSES REQUESTED Please rovlde method <br /> Time (Standard TAT) LI 48 Hours ❑ SDWA(Drinking Water) <br /> ❑ 7 Working Days ❑ 24 Hours ❑ CWA(Waste Water) <br /> ❑ 5 Working Days ❑ 2-8 Hours ❑ RCRA(Hazardo}is a <br /> Other <br /> Client Date 1 Time Matrix #of Cont "Ix'' �`ii�ia# <br /> Sample I D S m led Desc Cont �" ' ' Comments/ <br /> Sam Ie Temp(if regwred) <br /> ,.33s4AL i 1- ` 1 u � 5Ne <br /> 2 D 3 �o /s/o �. <br /> A-11 <br /> G 7 oz- <br /> 4 <br /> 5 -u 1b23sar <br /> 105 <br /> Low <br /> 7 -D3-3S lb3S - S � <br /> �.S e y J_ <br /> EN <br /> f7 <br /> 9 f� �G/S <br /> 10 ]7 -SD a <br /> G n r ;"' ? <br /> z� <br /> Re inquished By o Date/Time -/v-OL ad-� <br /> Relinquished By cz Receive <br /> Date/Time 2n <br /> Relinquished By Received By Date 1 Time <br /> Relinquished By Received By Date /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 />