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I♦ "1885IMs DMarHiii, 5034Q8960AX 78 - <br /> 2A_ E UOIA ANALYTICAL ❑ 1455 McDO Ivd, Suite D • Petaluma, CA 94954 + (707) 792-1865 • FAX (7 92-0342 <br /> Q ❑ 819 Striker Ave , Suite 8 + Sacramento, CA 95834• (916) 921-9600 • FAX (916) 921-0100 <br /> CHAIN 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 ,,,,.S t_ Protect <br /> Mailing Address 574-r I „j 54' 211.Z Billing Address (if different) <br /> City kr__ r Crvdc State CA Zip Code (- <br /> TelephoneKy- Fax# PO # <br /> Report To e 5 Lcc— ,t E-mail Address QC Data 40 Level II (standard) ❑ Level III © Level IV <br /> Sampler Date 1 Time Results Required Sequoia's Work Order# <br /> Turnaround 39f_ 10-15 Working Days ❑ 72 Hours MANDATORY ANA SES REQUESTED (Please Drovidemethod) <br /> Time (Standard TAT) ❑ 48 Hours D SDWA(Drinking Water) <br /> ❑ 7 Working Days ❑ 24 Hours ❑ CWA(Waste Water) <br /> ❑ 5 Working Days ❑ 2-8 Hours ❑ RRCRA Hazardous Wa <br /> Client Date 1 Time Matrix #of Con ` „ <br /> Sample I D Sampled Dese Cont Comments! <br /> �.Y Sam le# Tem If required) <br /> 1 2 i0 n 6w 3Wa1 q r� <br /> d y ` ri <br /> 4 M LV I7- v lid,, u w <br /> 5 YV '^ j {I e /�v V Irt i "" ip� <br /> �R.JJ r r t .i 4r <br /> b"'�t tan <br /> 6 <br /> ^`aka <br /> evi <br /> l <br /> _Y G► � �{ � I 4,y iMP <br /> 9 M w -2A 211 I t'j 3 <br /> 10 1A j1 lLo �. yV 4� I z F ` y sY 13� r fi <br /> r ' <br /> Relinquished By Date/Time12,112,1,- <br /> Relinquished <br /> 2 t 2 <br /> Relinquished By Z Recelved`"B}P�'x L Date 1 Time <br /> Relinquished B Received B Date 1 Time. 42 :7S ic <br /> Relinquished By Received Date 1 Time <br /> Were Samples Received in Good Condition? ❑ Yes ❑ No Samples on Ice? ❑ Yes ❑ No Method of dKipment Page of <br /> White Sequoia N Yellow Sequoia Pink Client <br />