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❑ 885 Jarvis Drive o Morgan Bill, GA 95037• (4Ub) f/b-9bVU• t-PA �WJ) RM-Wuns { <br /> OUOIA ANALYTICAL 0 1455 McDowell B orth, Suite D • Petaluma, CA 94954• (707) 792-1865 • FAX (7*10 <br /> 92-x342 <br /> ID El 819 Striker Ave., 8 •Sacramento, CA 95834• (916) 921-9600• FAX (916) 921- <br /> WAIN OF CUSTODY ❑ 1551 Industrial Road•San Carlos, CA 94070• (650) 232-9600 • FAX (650) 232-9612 <br /> ❑ 404 N. Wiget Lane o Walnut Creek, CA 94598•(925) 988-9600• FAX (925) 988-9673 <br /> Company Name: Project: r W 4L� , � <br /> u <br /> Mailing Address: 3 6 a O� Billing Address (if different): <br /> City: — St te: Zip Code: 4j5 ZS <br /> Telephone: _ 2_ rte Fax#: P.O. #: -z)zrl , U <br /> Report To: }G"66j E-Mail: �oct roc 1d,(, s . cowt_ OC Data: ❑ Level li (Standard) ❑ Level III E) Level IV Y <br /> c <br /> Sampler: Date/Time Results Required: Sequoia's Work.Order# a <br /> Turnaround 10- 15 Working Days ❑ 72 Hours MANDATORY: ANAL EOUESTED (Please provide method) <br /> Time: (Standard TAT) ❑ 48 Hours ❑ SDWA(Drinking Water) <br /> ❑ 7 Working Days ❑ 24 Hours LlCWA(Waste Water) <br /> ❑ 5 Working Days Cl 2-8 Hours ❑ RCRA(Hazardous Waste) <br /> Comments! <br /> ❑ Other Temp.(lf requited) <br /> Client Date/Time Matrix # of Container Sequoia's <br /> Sample I.D. Sampled Desc. Cont. Type Sample # <br /> f ro <br /> Cr <br /> 3. <br /> 4. t l7 <br /> 5. ICr'�s —D5 <br /> 0 <br /> 7. <br /> 8. <br /> 9. <br /> En <br /> quished By: <br /> Received By Date/Tim (� <br /> Relinquished By: Received By: Date 1 Time: <br /> Relinquished By: Received By: Date/Time <br /> Relinquished By: Received By: Date/Time: <br /> Were Samples Received in Good Condition? 0 Yes 0 No Samples on ice? 0 Yes ❑ No Method of Shipment Page of <br />