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IA ANALYTICAL <br /> I' ; V 1, 6$0 Chesape e'Drive • Redwood City, CA 94063 • (650) 364-9600 FAX (650) 3033'6 =' <br /> {� ❑ 819 Striker Ave., Suite 8 • Sacramento, CA 95834 • (916) 921-9600 FAX (916) 921-0100 <br /> CHAIN OF CUSTODY <br /> U 404 N.Wiget Lane • Walnut Creek, CA 94598 • (510) 988-9600 FAX (510) 988-9673 <br /> Company Name:AX Project Name: 1 17, { j <br /> S ;at <br /> ff ` �+ <br /> Address: //f 7 1-Orti L � - -lawvl—ls�:[.rt't ` �� 7Z S <br /> `` rc? Ave �$�f 1,,� Billing Address (if different): _ <br /> City: 0 �S�`tC7 S /. Zip Code: � _-- <br /> Telephone:Zp�w ' �� <br /> S ? FAX 4#:Z�j-r�' �'Z�Zj� P O. #: <br /> tyre�,�1 <br /> Report To: u��` R tt Sampler: TD <br /> �4 C�.�c1c7►rr.,s QC Data: evel D (Standard) U Level C U Level B U Level A <br /> Turnaround Airl Working Days U 3 Working Days U 2 - 8 Hours ❑ Drinking Water Analyses Requested <br /> Time: U 7 Working Days U 2 Working Dao_ <br /> Ys U Waste Water <br /> U 5 Working Days 1.124 Hours 9ff J'JU f P 61her <br /> Client Dato/Time Matrix # of Cont. Sequoia's <br /> Sample LD- Sampled Desc. Cont. Type Sample # Comments <br /> 1Z1( q8 11aS <br /> - - 5 _ _ ass__ E/ _,�_ _✓ <br /> � 2. W -2 <br /> to _ S a�- ✓ t?l <br /> Lla <br /> 4. } <br /> 5. <br /> 6. <br /> i <br /> 7. ro <br /> 0 <br /> $. M <br /> Cr <br /> 9. <br /> I i' ':�elnlgilfshed By: Date: Time: Received B <br /> 1, " Y:zi� �.�C-l�-� Date: �� l� ��i Time: [)8'`-]5— <br /> Y_i; 'pelinquished B �r �cv2t�>rif Date:r /� �`� Time: 11$� Received B <br /> Y Date: Time: <br /> ielittquished By: Date: Time: Received By Lab: `J Date: 7 Time: //YZ <br /> Ware Sa�ples Received in Good Condition? U Yes U No f l <br /> Samples on Ice? C11'ges ❑ No Method of Ship�nent�iC1Q,��� Page i at r <br />