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,*•°""'^�yf, SPATE OF CALIFORNIA—ENVIRONMENTAL PROTECTION AGENCY <br /> REGIONAL WATER QUALITY CONTROL BOARD <br /> Cr- <br /> 3443 <br /> CENTRAL VALLEY REGION illi G",1 Il\1 l�J -l1 <br /> 3443 ROLMER ROAD,SUITT A • SACRAMENTO,CA 95827-3098 <br /> PHONE: (916)255-3000 • FAX: (916)255-3015 <br /> PROGRAM PCA PROJECT NAME FIELD <br /> ANALYSIS REQUIRED CONDITIONS <br /> G�e✓ra� - I�(C'vJ 4 —� trswv.,wwo,Erc.� <br /> SAMPLER Ignature) PRINT NAME w <br /> S A M P L E CONTAINER MATRIX m w <br /> IDENTIFICATION LOCATION DATE TIME TYPE NO. WATER WASTE- SOIL/ U C7'ti(L (0 <br /> WATER SLUDGE <br /> LAB NO. <br /> vel w —i 3 ¢ I �w, ✓� l i 7 �a VOA Z, / ✓ <br /> -- <br /> SPECIAL INSTRUCTIONS/SUSPECTED CONSTITUENTS <br /> zlo,0 /e : 1, - /lez.-, ;�� >L��lf . A' <br /> RELINQUISHED BY (Signature) DATE/TIME IRECEIVED BY (, Signature) RELINQUISHED BY (Signature) DATE/TIME RECEIVED BY (Signature) <br />