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❑ 885 Jarvis Drive • Morgan Hill, CA 95037 + (408)776-9600 + FAX (408) 782-6308 <br /> 4DSEQUOIA ANALYTICAL ❑ 1455 McDowell Blvd, Suite D. • Petaluma, CA 94954• (707)792-1865 • FAX (707) 792-0342 <br /> 4 �C 14 819 Striker Ave., Suite 8 • Sacramento, CA 95834• (916)921-9600 • FAX(916) 921-0100 <br /> CHAIN OF CUSTODY ❑ 1551 Industrial Road • San Carlos, CA 94070+ (650)232-9600 • FAX (650)232-9612 <br /> ❑ 404 N. Wiget Lane • Walnut Creels, CA 94598 • (925)988-9600 + FAX(925) 988-9673 <br /> Company Name: ;� S4 -� P'SS6 c.. Project: �d a+XY�S <br /> Mailing Address: P p Z tv,,�S `o_Q Billing Address (if different): <br /> City: U6State: C.(A Zip Code: :I S <br /> I <br /> Telephone: 20� -3(y`} -3 1 Fax#: 2-0 ci -_3 2 P.O.#: <br /> Report To: c a E-mail Address: A sem_ C6y TQC Data: O Level II (standard) ❑ Level III ❑ Level IV <br /> Sampler: Date/Time Results Required: Sequoia's Work Order 4-540 lc�y!fta <br /> Turnaround 'y k 10-15 Working Days ❑ 72 Hours MANDATORY: ANALYSES REQUESTED Please Drovide method <br /> Time: (Standard TAT) ❑ 48 Hours ❑ SDWA(Drinking Water) <br /> ❑ 7 Working Days ❑ 24 Hours ❑ CWA(Waste Water) y <br /> ❑ 5 Working Days ❑ 2-8 Hours ❑ RCRA(Hazardous Waste) �J <br /> ❑ Other <br /> Client Date/Time Matrix #of Container Sequoia's Comments/ <br /> Sample I.D. Sampled Desc. Cont- Type Sample# Temp.Qf required) <br /> r �1a0/CXR ;C0 <br /> 7-. I"v0 <br /> 2. <br /> 3. <br /> i 4. <br /> i <br /> 1 5 <br /> i 6 <br /> t 7. <br /> 8. <br /> 9. <br /> fl <br /> 10. <br /> i Relinquished By: Received By: p Date/Time: <br /> Relinquished By: Received By: Date/Time: <br /> Relinquished By: Received By: Date/Time: <br /> Relinquished By: Received By: Date/Time: <br /> i <br /> Were Samples Received in Good Condition? Yes ❑ No Samples on Ice? ) Yes ❑ No Method of Shipment: Ji!PYi�Z Page—Lof� <br /> White: Sequoia Yellow: Sequoia Pink:Client <br />