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MMd&ONM I♦ M M M MIM <br /> MALIMICAT ❑ 680 Ches ke Drwe • Redwaad Crty, CA 94063 • (415) 364-9600 FAX (415 -9233 <br /> ❑ 819 West nker Ave • Sacramento, CA 95834 • 1,916) 921-9600 FAX (916) 1-0100 <br /> CHAIN OF CUSTODY ❑ 1900 Bates Ave , Suite LM • Concord, CA 94520 • (510) 686-9600 FAX (510) 686-9689 <br /> Company Name ;G R,t t5o,/,/ Project Name <br /> Address -T3 C Billing Address ( if ddferent) <br /> City C,+r4e;za-r State C Zip Code g S-0s;-Z <br /> Telephone FAX# S' fL P O # <br /> ,Report To kamplerC =�? �rZ e, 10C Data ❑ Level A(Standard) ❑ Level B ❑ Level C ❑ Level D U <br /> Turnaround J6 10 Working Days ❑ 3 Working Days ❑ 2 -8 Hours ❑ Drinking WaterAnal ses Requested! <br /> a <br /> Time LI7 Working Days ❑ 2 Working Days ❑ Waste Water <br /> ❑ 5 Working Days ❑ 24 Hours ❑ Other <br /> Client Date/Time Matrix #of Cont Sequoia's <br /> Sample I D Sampled Desc Cant Type Sample# Q Comments <br /> t <br /> s <br /> U) <br /> 3 <br /> a� <br /> a <br /> 5 <br /> 6 <br /> 7 <br /> a <br /> $ w <br /> U) <br /> 9 <br /> t <br /> 10 <br /> Relinquished By Date Time 3'v z. Received By Date Time <br /> Relinquished By Date Time Received By Date Time <br /> RelinquiskedBy I Date ITime lReceived By Lab ;14 52 Date �1(o ime <br /> Were Samples Received in Good Condition?0 Yes O No Samples on Ice? D Yes ❑ No Method of Shipment Page_of <br />