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Vl� PRQHLTTil.9�R -404-7get •Walnut Creek, CA 94� • (9�25988-9600UFAXFAX 9108'8.9(J � <br /> HAIN OF CUSTODY ❑ 1455 McDowe Ivd North, Suite D • Petaluma, CA 94954 • (707j 792-1865 FAX ) 792-0342 <br /> ❑ 1551 Industrial Road • San Carlos, CA 94070• (650) 232-9600 FAX (650) 232-9612 <br /> Company Name . f,5 �" Project Name <br /> Mailing Address Billing Address (if different) <br /> City Statel ( _ Zip Code r11 : <br /> Telephone ass _ 7 FAX # PO # <br /> Report To _ ? ,'� Sampler �l, /1 ,� �f i ff QC Data ❑ Level II (Standard) ❑ Chromatograms ❑ Level III ❑ Level IV v <br /> Y <br /> Turnaround Standard ❑7 Working Days ❑2 Working Das ❑ Drinking Water Analyses Requested <br /> 10-15 � <br /> Time ❑ 5 Working Days ❑ 1 Working Day ❑Waste Water ��t <br /> Working Days <br /> ❑3 Working Days ❑ASAP ❑Other <br /> Client Date/Time Matrix # of Cont Sequoia's x Comments <br /> Sample I D Sampled Desc Cant Type Sample # <br /> 0 <br /> Cr <br /> U) <br /> 3t� 03�j ,�3� ���tt`4 -� UG ✓ �! 30 <br /> 5 <br /> 6 <br /> 7 0 <br /> 0 <br /> 8 ami <br /> a U <br /> -9 (D <br /> 10 <br /> Relinquished By �ti r ,!'f Date ;'.c., r Time /; s Received By Date Time <br /> Relinquished By r �fi Date Time Received By Date Time <br /> Relinquished By Date Time Received By Lab rte_ �� Date �z Time <br /> Were Samples deceived in Good Condition? ❑Yes ❑No Samples on Ice? ❑Yes ❑ No Method of Shipment Page_of <br />