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i <br /> 680ChesaF.*Drive • Redwood City, CA 94063 • (415) 364-9600 FAX (415) 09238 <br /> Sr UO1A ANALYTICAL 819 West Striker Ave. •Sacramento, CA 95834 - (916) 921-9600 FAX (916) 921-01M <br /> �� •1 CHAIN OF CUSTODY ❑ i90o Bates Ave., Suite LM• Concord, CA 94520 • (510) 686-9600 FAX (510) 686-9689 <br /> Company Name: �� Project Name: fiivL' 4'Ta 0-W41,16" <br /> Address: A/33 A/. h.4 Qc yy, Billing Address( il different): <br /> City: _5e9eAv ntT State: C4 Zip Code: 9�k3 y <br /> Tele hone ff 2-8 -3?va FAX#:(90 94,31 V P.O.#: 513/ 1 <br /> U <br /> Re rt To: SIM I°l TT Sam ler: OC Data: Level A(standard) ❑ Level B ❑ Level C ❑ Level D Y <br /> C <br /> Tumaround ❑ 10 Working Days 3 rki Days ID2 -8 Hours ❑ Drinking Water lAnatyses Requested a. <br /> Time: ❑ 7 Working Days iDays y ❑ Waste Water .� <br /> ❑ 5 Working Days ❑ 24 Hours --F/ROther <br /> Client Date/Time Matrix #of Cont. Sequoia's <br /> Sample I.D. Sampled Desc. Cont. Type Sample# Comments <br /> ca <br /> or- <br /> 3. <br /> t- <br /> 0 <br /> 3. } <br /> 4. <br /> 5. <br /> 6. <br /> 7. o <br /> a <br /> Cr <br /> m <br /> 8. rn <br /> .r <br /> 9. t <br /> 10. Li <br /> Relinquished By: Ap. Date: t Ttme:/OOr Received By: Date: rime: <br /> Relinquished By: Date: Time: Received By: Date: Time: <br /> r <br /> Relinquished By: Date: Time: Received By Lab: j4tx� � ` ime: 1 : {, Z? <br /> Were Samples Received in Good Condition?0 Yes 0 No Samples on Ice? ❑Yes)& Method of Shipment 54.• ^i-A _ Page L of .f <br />