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1 ftUOIA ANALYTICAL 1-1180 Chesapeak e • Redwood City, CA 94063• (650) 364-9600 FAX (650) 364 <br /> ❑ 819 Striker Ave , ite 8 • Sacramento, CA 95834 • (916) 921-9600 FAX (916) 921-01 <br /> 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 �( `_:C960 t-k 5 Protect Name `; A,r. .�� c G..�J t <br /> Mailing Address ���, ����,,, , Billing Address (if different) <br /> City �Ic��� j State Zip Code T5 3 <br /> Telephone Zz%�l 5 - L Z Ll FAX # Z ! - U 1,5 PO # <br /> t � m <br /> Report To 6,r f.w V v, A 1 _ Sampler r L• I' ���� QC Data �evel D (Standard) U Level C ❑ Level B ❑ Level A v <br /> Turnaround �0 Working Days ❑3 Working Days ❑2 - 8 Hours CJ Drinking WaterAnalyses Requested <br /> d <br /> Time ❑ 7 Working Days ©2 Working Days ❑Waste Water <br /> ❑ 5 Working Days ❑24 Hours ❑Others AA <br /> Client Date/Time Matrix # of Cont Sequoia's r,\�`� Comments <br /> Sample I D Sampled Desc Cont Type Sample # \ > <br /> 4 <br /> < �� <br /> o <br /> 2 ( -neat-� Q ',`�iZCr <br /> 3 RvS�-N+wz-1Y l�z5 ( / �( .0 <br /> 0 <br /> 212.5 \/ r <br /> 4!C'V%D-M� lVS� JS <br /> 5 ��,SD- M�Z-' tt0 <br /> 6 Q Zr 4M <br /> i <br /> 7 I't15& IUwt3-Zt�. i5f5 �( �` <br /> Cr <br /> 03 �5'! a) <br /> a� <br /> 9 L <br /> 10 <br /> Relinquished By -� ` ,� _� _ Date (,7 it Time 0- el Received By ,�r�. ► y r �s,.y, �. Date ► t t , Time <br /> F <br /> J <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? 0 Yes ❑ No Samples on Ice? ❑Yes ❑ No Method of Shipment Page_of <br />