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U � 80 ape - nve wo ty, 0 063 0) 3 00 M(65( -n !♦ <br /> 19 n er Ave ite 8• acramento, CA 95834 • (916) 921-9600 FAX (916) 921- <br /> � HAiN OF CUSTODY ❑ 404 N Wig L_ Walnut Creek, CA 94598 + (925) 988-9600 FAX (925) 988-9673 <br /> ❑ 1455 McDowell Blvd North, Suite D • Petaluma, CA 94954%(707),792-1865 FAX (707) 792-0342 <br /> Company Name Project Name tA „ <br /> Mailing Address inn V Lo 2 00 Billing Address (if different) <br /> City s-A "D State CA Zip Code '° <br /> Telephone t� ?tan ILOr� FAX #���� �o�-811.0� PO # �g-� �"t2�—�c��.�r�� <br /> Report To (`AV, � Sampler �� OC Data ❑ Level D (Standard) ❑ Level C ❑ Level B ❑ Level A U <br /> Turnaround1 10 Working Days ❑3 Working Days ❑2-8 Hours El Drinking Water Analyses Requested - � <br /> a <br /> Time ❑ 7 Working Days ❑2 Working Days Q Wltste Water - <br /> ❑ 5 Working Days ❑24 Hours ❑Other c ' <br /> Client Date/Time Matrix # of Cont Seguoi;La's <br /> Sample ! D Sampled Desc Cont Type Samplo # Comments <br /> P <br /> 3 <br /> ti r <br /> �x rt <br /> A`ca� :.3 mar � � e � pv'� oar �.� � � � x "" <br /> '.z f c 4x'r !v <br /> z , r 4A <br /> 71 >� K 1 3 _ ssse o- <br /> 6 c _G s ' ''r'jy <br /> a ` ��`r <br /> -7 ` <br /> ! �~ Ftp.E � — wc `Cs '' y5 '��"'`'s ��'`` `rte �"'� �5.'f Psg <br /> `4^J <br /> 8 VJ <br /> t <br /> y 10 <br /> Y <br /> Relinquished Ely Datl Time Received By Date Time <br /> Relinquished By Date Time Received By Date Time <br /> Relinquished By Date Time Received By Lab { - ate 4�0 Time O Vii <br /> RA- <br /> Were Samples Received in Good Condition? ❑Yes ❑No Samples on Ice? ❑Yes ❑No Method of Shipment 11 r Page-k--of—1 <br />