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❑ 680 Chesapeake Drive • Redwood City, CA 94063 • (650) 364-9600 FAX (650) 364-9233 <br />❑ 819 Striker Ave., Suite 8 • Sacramento, CA 95834 • (916) 921-9600 FAX (916) 921-0100 <br />404 N. Wiget Lane • Walnut Creek, CA 94598 a (510) 988-9600 FAX (510) 988-9673 <br />Company Name: <br />n e p j <br />Project Name: 6U) S 12 V /Ja in ec <br />Address: SOA <br />e <br />Billing Address (if different): <br />City: L1 vc <br />Zip Code: <br />S ate:CA <br />- <br />Telephone: 2 S <br />01 6-K -V15-U FAX �37 <br />P.O. #: <br />Report To: <br />Time: <br />Sampler: Ch r i -S <br />QC Data: Level D (Standard) ❑ Level C ❑ Level B ❑ Level A <br />Turnaround ❑ 10 Working Days ❑ 3 Working Days U 2 - 8 HouftJ <br />Time: U 7 Working Days U 2 Working Days <br />® 5 Working Days ^1 4 Hours <br />U Drinking Water <br />❑ WasteWater <br />Other <br />Time:5,/7 <br />Client <br />Sample I. D. <br />Date/Time <br />Sampled <br />Matrix <br />Desc. <br /># of <br />Cont. <br />Cont. <br />Type <br />Sequoia's <br />Sample # <br />Received By: <br />1. ®- ad) <br />5 <br />S0 <br />Time: <br />T51006:;0 <br />Time: / <br />2. <br />b <br />4. <br />5. <br />6. <br />7. <br />8. <br />im <br />Analyses Requested <br />Comments <br />Relinquished By: <br />Date/,0-6--yr <br />Time:5,/7 <br />Received By: <br />Date: <br />Time: <br />Relinquished By: <br />Relinquished By: <br />Date: <br />Time: <br />Received By: <br />Date: <br />Time: <br />Date: <br />Time: <br />Received By Labs _l � <br />Date: /VA<1 <br />Time: / <br />Were Samples Received in Good Condition? U Yes ❑ No Samples on Ice? U Yes U No Method of Shipment Page — of <br />