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01TA/`1 L I`1 RR1�/elm 40 CAWak4e • WoodOW CA=3 • 4"3644W FAW50) <br /> © 819 Striker Ave , 8 • Sacramento, CA 95834 • (916) 921-9600 FAX (916) 921-01 <br /> AIN 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 ATc A-5-S42 <br /> _ Protect Name _ <br /> Mailing Address 7 - Billing Address (if different) <br /> Citye-620 L10 14 State Zip Code <br /> Telephone _5rl _ FAX # p_rr� _ PO # <br /> Report To Sampler QC Data 4TLevel D (Standard) © Level C ❑ Level B U Level A Ca <br /> Turnaround 10 Working Days ❑3 Working Days ❑ 2 - 8 Hours ❑ Drinking Water Analyses Requested <br /> Time ❑ 7 Working Days ❑2 Working Days ❑Waste Wateri Q <br /> C) 5 Working Days C324 Hours , 4/Other Cf k1 <br /> Qf <br /> Client Date/Time Matrix # of Cont Sequoia's +G [ <br /> Sample I D Sampled Desc Cant Type Sample # 105)� Comments <br /> i M W— 4/2999 `7 Wass � f/ <br /> 0 <br /> Cr <br /> a) <br /> U) <br /> 3 ^_ a <br /> 4 <br /> 5 <br /> 6 <br /> 7 <br /> 0 <br /> 0, <br /> 8 W <br /> 9 <br /> t <br /> 10 <br /> Relinquished By �( , Date CYZ�9y Time Received B Date 1- CA�q Time `6 <br /> Relin uished B Date Time Received B Dat <br /> q Y e Time <br /> Y <br /> Relinquished By C Date Time Received By Lab AA oyd Date _ Time 1 <br /> Were Samples Received in Good Condition? ❑Yes ❑ No Samples on Ice? to es 0 No Method of Shipment CO viee�?— Page l of <br />