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51 885 Jarvis Drive • organ Hill, CA 95037 • (408) 776-9600 • FAX (408) 782-6308 <br /> *QUOIA ANALYTICAL N Striker <br /> Wiget Lan alnut Creek, 4 <br /> , CA 598$ 6 00 FAX (916) 9 <br /> (925) 988 9600FAX (25) 98896701 <br /> ❑ 404 + <br /> 1W CHAIN OF CUSTODY ❑ 1455 McDowell Blvd North, Suite D • Petaluma, CA 94954 • (707) 792-1865 FAX (707) 792-0342 <br /> ❑ 1551 Industrial Road • San Carlos, CA 94070 • (650) 232-96/00 FAX (650) 232-9612 <br /> Company Name d J S�n C e ra d Project Name 1n "r'e ��r 411 --�,�e 2 5 7 rt»l <br /> Mailing Address :1/,7 et1n4_ �A ItO Al ���� It Billing Address (if different) <br /> City , s�`f State Zip Code [ � <br /> Telephone' _ l FAX # I C) - La ?� � PO # a <br /> Report To a A � �� Sampler QC Data W evel D (Standard) 11eveeve <br /> p Level C ❑ Ll B ❑ Ll A rJ <br /> � �" t< a �/ �r � , <br /> Turnaround -4vWorking Days ❑3 Working Days ❑ 2 - 8 Hours ❑ Drinking Water Analyses Requested <br /> CL <br /> 'Gime C17 Working Days ❑2 Working Days CJWaste Water <br /> 5 Working Days ❑24 Hours ¢ Other <br /> Client Date/Time Matrix # of Cont Sequoia's /t� <br /> Sample I D Sampled Desc Cont Type Sample # <br /> f Comments <br /> '� �� <br /> 1 JA VJ- I . t uCi 1 <, v"I a LX),V11 � � <br /> —5 a� y O� <br /> 2 fA VJ- V m <br /> J U) <br /> O <br /> 4 52 <br /> 5 55 �� <br /> 6 1VJ 3 VA40t/r <br /> 7 �. 3C � � o <br /> 6 <br /> 8 rn <br /> m <br /> 9 r <br /> 10 <br /> Relinquished By , 7 r 7 1 l L Date Time Received By Date 1, Time 7 <br /> Relinquished By Date Time Received By Date Time <br /> Relinquished By Date Time Received By Lab Date Time <br /> Were Samples Received in Good Condition? ❑Yes ❑ No Samples on Ice? P Yes ❑No Method of Shipment; r, �; t V +.r Page of <br />