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80 C esapea [Ite <br /> ve • Redwood A 940 <br /> City, C63• (650) 364-9600 FAX (650) 364 <br /> ` QUOIA ANALYTICAL c3819 Striker Ave , 8 - Sacramento, CA 95834 - (916) 921-9600 FAX (916) 921-0 - <br /> ❑ 404 N Wiget Lane -Walnut Creek, CA 94598 - (925) 988-9600 FAX (925) 988-9673 <br /> CHAIN OF CUSTODY <br /> ❑ 1455 McDowell Blvd North, Suite D - Petaluma, CA 94954 - (707) 792-1865 FAX (707) 792-0342 <br /> Company Name I TC, q�eS �hG _ Project Name � Y10,kntC' 1t <br /> Mailing Address 12J , G� Billing Address (if different) <br /> City State C Zip Code 1 <br /> Telephone-709 -574�_ ZZ2 FAX # 7,0q-571- 2ZZS Po # <br /> =Report YeSampler X fp s QC Data -Level D (Standard) © Level C ❑ Level B ❑ Level A U <br /> Y <br /> Turnaround 10 Working Days ❑3 Working Days ❑2 - 8 Hours ❑ Drinking Water Analyses Requested <br /> d <br /> Time ❑ 7 Working Days ❑2 Working Days ;ZI;Wa to Water <br /> ❑ 5 Working Days ❑24 Hours 3 cher <br /> Client Date/Time Matrix # of Cont Sequoia's �� z �w C o Comments <br /> Sample I D Sampled Desc Cont Type Sample # +Gc� <br /> rl�k5 5 - P '`i It, V V/ v — <br /> � <br /> 2 M1l� Z 113C $ ✓ ✓ ✓ L/ D <br /> w -3 �i�� v.l g ✓ ✓ ✓ ,/ o <br /> 4 <br /> 5 <br /> 6 <br /> �n <br /> 7 0 <br /> Cr <br /> a� <br /> 8 <br /> a� <br /> 9 L <br /> 10 <br /> �0 {q <br /> Relinquished By [� Date Time Received By Date Q �t1 !� Time j QQ <br /> Relinquished By Date Q "f,?- Time 1,;�0-0 Received By Date, Time <br /> Relinquished By Date im Received By Lab �yyL jooL[� Date{/ 1 Lj Time f �� <br /> Were Samples Received in Good Condition? Ll Yes O No Samples on Ice? 01Y/es ❑ No Method of Shipment C00f"a 02M Page _r_ of 3 <br />