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9600 FAX <br /> 50) <br /> &Q-UOIA ANALYTICAL p gag Striker pA ek, ite 8 Sacramento, <br /> acr en City, CpA99583 3.(916) 921-9600 <br /> 2649600 AX (9616) 926 01 <br /> 4W CHAIN OF CUSTODY ❑404 N Wiget Lane •Walnut Creek, CA 94598 • (925) 988-9600 FAX (925) 988-9673 <br /> ❑ 1455 McDowell Blvd North, Suite D • Petaluma, CA 94954 • (707) 792-1865 FAX (707) 792-0342 <br /> Company Name �� �; f�Ss — Protect Name <br /> 1 It7 �5 C ?t <br /> Marling Address 7 Billing Address (if different) <br /> City © State ., Zip Code <br /> Telephone�a s I FAX # Zd 9 �� PO # r r <br /> p� <br /> Report To Sampler QC Data : I Level D (Standard) ❑ Level C ❑ Level B ❑ Level A v <br /> Turnaround 10 Working Days U 3 Working Days ❑2-8 Hours ❑ Drinking Water Analyses Requested c <br /> Time ❑ 7 Working Days ❑2 Working Days ❑Waste Water p� ��71 y <br /> IL <br /> ❑ 5 Working Days ❑24 Hours Other C* <br /> Client Date/Time Matrix # of Cont Sequoia's <br /> G f `L Comments <br /> Sample I D Sampled Desc Cont Type Sample # G <br /> 2 114 0j- 3 �r o <br /> 3 � <br /> 0 <br /> 4 <br /> 5 <br /> 6 <br /> 7 T <br /> b <br /> 3 <br /> 8 ) <br /> 9 m <br /> L <br /> 10 <br /> Relinquished By s�� � � Date t ,?,k1l y Time Received By,\ �,r lF r�cry� Date , `�—�1 Time /lry <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 ❑fro Samples on Ice? U' es CJ No Method of Shipment cam; �.r.. •'� t��_ Page of 1t <br />