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M M85 T Dn or�ill, 1 5039*08)M60()�X (#782-M M M <br /> �UOIA ANALYTICAL ❑ 145ow d, Suite D • Petaluma, CA 94954 • (707) 792-1885 • FAX {70 -0342 <br /> 819 Striker Ave , uite 8 • Sacramento, CA 95834 • (916) 921-9600 • FAX (916) -0100 <br /> AAIN OF CUSTODY ❑ 1551 Industrial Road • San Carlos, CA 94070 + (650)232-9600 + FAX (650) 232-9612 <br /> 0 404 N Wiget Lane + Walnut Creek, CA 94598 • (925) 988-9600 • FAX (925) 988-9673 <br /> me � _ F��,-cc1,�r t"�i Protect r, ,, S ipv opo <br /> ress Billing Address (if different) <br /> Ci State Zip qpde <br /> Telephone Fax# PO # <br /> Report To—T>&.,j t�cr� ,c.- E-mail Address QC Data Level Il (standard) ❑ Level III ❑ Level IV <br /> Sampler Date 1 Time Results Required Sequoia's Work Order# <br /> Turnaround ¢� 10-15 Working Days EI72 Hours MANDATOR ANALYSES REQUESTED Please rovide method <br /> Time / (Standard TAT) ❑ 48 Hours ❑ SDWA(DrinkingWater) <br /> ❑ 7 Working Days ❑ 24 Hours CWA(Waste Watert <br /> ❑ 5 Working Days ❑ 2-8 Hours ❑ RCRA(Hazardo k as e) <br /> ❑ Other z�;� ��� �'� r <br /> Client Date 1 Time Matrix #of Conia s[ tr i <br /> ! ' Comments/ <br /> Sample I D Sampled Desc Cont V'; Sample# Temp(If required) <br /> 1 <br /> 2 4/7 Z' I AfV_ <br /> i !r yif lYf N K. / z7rt <br /> 4 Z:>—? L:L <br /> 41$ <br /> If 4 <br /> 3 <br /> 5 <br /> , <br /> \^t 5T 1kJA Ic} all,6 qrW {} A <br /> 8 Ak# t 'Er+7 v"Ffft�rY" R R f d!La 11 K S/i <br /> f-.� <br /> t ' <br /> . A j R <br /> 10 <br /> Relinquished By Date/Time -D <br /> Relinquished By Receive ` Date/Time <br /> Relinquished By Received By Date I Time <br /> Relinquished By Received By Date 1 Time <br /> Were Samples Received In Good Condition? ❑ Yes ❑ No Samples on Ice? ❑ Yes ❑ No Method of Shipment Page of <br /> I <br /> White Sequoia Yellow Sequoia Pink Client <br />