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,!D &UOIA ANALYTICAL e68� Ch apeDrive • Recdwood City, CA 94063 • (650) 364-9600 FAX (650) 3+ 33 <br /> ❑ $19 Striker Ave , Suite 8 • Sacramento, CA 95834 • (916) 921-9800 FAX (918) 921-0100 <br /> Vw CHAIN OF CUSTODY ❑ 404 N Wiget Lane • Walnut Creek, CA 94598 • (510) 988-9600 FAX (510) 988-9673 <br /> Company NamePro Project Name . <br /> Address ' f-1 Billing Address (if different) <br /> City : E t r°; . t"} State t Zip Code <br /> Telephoney �� f%: ; FAX # .'fid 3/ 4 �. PO # m <br /> ReportTo Sampler QC Data U1 evel D (Standard) 0 Level C ❑ Level B © Level A U <br /> Y <br /> Turnaround i o Working Days ❑3 Working Days ❑2 -8 Hours 0 Drinking Water Analyses Requested <br /> I Time ❑ 7 Working Days ❑ 2 Working Days ❑Waste Water <br /> ❑ 5 Working Days ❑ 24 Hours eOther <br /> Client Date/Time Matrix # of Cont Sequoia's = � Comments <br /> Sample I D Sampled Desc Cont Type Sample # ; <br /> nam <br /> 0 <br /> 2 cif " 2 <br /> co <br /> 0 <br /> I <br /> p { <br /> 6 # 6, 1, t <br /> 7 LZ <br /> 0 <br /> M <br /> 0- <br /> 8 con <br /> m <br /> 9 c <br /> 10 <br /> Relinquished By A1 r�'t, , Date I2u s q Time Received By j ! ` jf Date f- `1 ' Time �— <br /> t, <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 Condition9 ❑Yes ❑ No Samples on Ice? Ves ❑ No Method of Shipment s?�M` Page of <br />