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*]MAIN <br /> UOfA ANAL"YTICAL ❑ 1455 McDowell Blv arth, Suite D • Petalluma, CA 94954• (707) 792-1865 • FAX (707 q2-0342 <br /> IW <br /> ❑ 819 Striker Ave., S , • Sacramento, CA 95834• (916) 921-9600 • FAX (916) 921-01qV OF CUSTODY ❑ 1551 Industrial Roa - San Carlos, CA 94070• (650) 232-9600 • FAX (650) 232-9612 <br /> ❑404 N. Wi t Lane Walnut Creek, CA 94598• (925) 988-9600 • FAX (925) 988-9673 <br /> FMailing <br /> Name: Project: { � <br /> ddress: 33b A-,, Billing Address (if different): <br /> City: !Na r State: Ck. Zip Code: i 52 s`2— <br /> Telephone: ?.CJC Z 7 Z_3� 2.o Fax#: S,4�yt L: P.O. #: rt f a T <br /> U <br /> Report To: G( ,���, E-Mail: QC Data: P.evei II (Standard) ❑ Level III ❑ Level IV <br /> Sampler: Date/Time Results Required: Sequoia's Work Order# a <br /> Turnaround ) 10- 15 Working Days ❑ 72 Hours MANDATORY: ANAL S REQUESTED (Please provide method) <br /> Time: (Standard TAT) ❑ 48 Hours ❑ SDWA(Drinking Water) ` <br /> ❑ 7 Working Days ❑ 24 Hours ❑ CWA(Waste Wate7) 0 <br /> ❑ 5 WorkingDas ❑ 2-8 Hour ❑ RCRA Bazar �� ;�, <br /> Y s (Hazardous Waste <br /> Qom-,encs! <br /> ❑ Other ,� Temp.Qi required} <br /> Client DatelTime Matrix # of Container Sequoia's <br /> Sample I.D. Sam led Desc. Cont. Type Sarn le# <br /> T1- 'a <br /> 2. <br /> 3. <br /> 0 <br /> 4. K - p <br /> 5. (<r-s Nil o <br /> 6. tCF <br /> 7. KrY U) <br /> 8. W <br /> Relinquished By: Received By: Date/Time: <br /> Relinquisher! By: Received By: Q Date/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 />