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�iW80 Chesapeak e • Redwood City, CA 94063 • (650) 364-9600 FAX (650) 364- I ,i tQUOIA ANALYTICAL <br /> ❑ 819 Striker Ave., e 8 • Sacramento, CA 95834 • 916 921-9600 FAX 916 921-01 <br /> ( ) ( ) f <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: A55 4 Project Name: -4,en VSD, <br /> Mailing Address: /I)7 to Y$4 him c $ Billing Address (if different): <br /> City: Me8Q,., -p State: ca Zip Code: 95 <br /> Telephone:2p4-579-ZZ FAX #:Zpq_5?9-2225 P.O. #: <br /> Report To: Sampler: Aix T-toreS QC Data: Level D (Standard) I C ❑ Level B ❑ Level A U <br /> Turnaround LX0 Working Days ❑3 Working Days 0 2-8 Hours ❑Drinking Water Analyses Requested <br /> Time: ❑ 7 Working Days ❑2 Working Days ❑Waste Water u1 <br /> ❑ 5 Working Days ❑24 Hours �1 Other Qv �¢ <br /> Client Date/Time Matrix # of Cont. Sequoia's ��` o�a� Comments <br /> Sample I.D. Sampled Desc. Cont. Type Sample # <br /> y0ml ..e z 0 ¢,,e. <br /> 1. LuMme- I azz�a4 a�3 � S ss G ✓ � o <br /> 2. kl%K- a' <br /> 3. a <br /> r <br /> 4. <br /> 5. <br /> 6. <br /> cc <br /> 7. "o <br /> 8. m <br /> a' <br /> 9. <br />' 10. <br /> Relinquished By: -� ,4�1,C.,i Date:D LZ6 9 Time: Received By: Date:3 -/ yr Time: Ji.'-Io <br /> Relinquished By: „J DateJ-j-1y Time: `7, Received By: Date: Time: <br /> Relinquished By: Date: Time: Received By Lab: Date:3 Time: <br /> Were Samples Received in Good Condition? ❑Yes 0 No Samples on Ice? Riles ❑No Method of Shipment Chun ! Page of <br />