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!o AMynACM J0 btri ve , tS •@KmeWkA 9M • (A"Z1-AWFA�) 9 <br /> U 404 N Wiget Larilalnut Creels, CA 94598 • (925) 988-9600'FAX (925) 988-9673 <br /> Wo CHAIN OF CUSTODY U 1455 McDowell Blvd North, Suite D • Petalufna, CA 94954 • (707) 792-1865 FAX (70r92-0342 <br /> C7 1551 Industrial Road • San Carlos, CA 94070 • (650) 232-9600 FAX (650) 232 9612 <br /> Company Name t Project Name -,4 <br /> ss <br /> Mailing Address G 2� CwrY+na}���a. Billing Address (if different) <br /> City L.� State L Zip Code <br /> Telephone Z.a -Or/ L FAX # 2.,9 369-o fid'_— PO # <br /> Report To Sampler � gL,� QC Data OCevel D (Standard) U Level C U Level B U Level A — U <br /> x <br /> Turnaround Pk 10 Working Days U 3 Working Days U 2-8 Hours U Drinking Water Analyses Requested � <br /> Time U 7 Working Days ❑2 Working Days U Waste Water IL <br /> U 5 Working Days ©24 Hours U Other q <br /> Client Date/Time Matrix # of Cont Sequoia's ,Qr <br /> Sample I D Sampled Desc Cont Type Sample # r Comments <br /> Ate b <br /> Q <br /> 7 V111* CT <br /> m <br /> 3 o <br /> 4 <br /> 7 0 <br /> :T <br /> 8_ -- - - lSC� v, <br /> 9-- - <br /> 10 <br /> Relinquished By Date/ 3 Y Time Received By Date Time <br /> i Retinquished By Date Time Received By Date Time <br /> Relinquished By Date Time Received By Date Time <br /> i <br /> Wei e Samples Rerowd in Good Condition? U Yes U No Samples on Ire? U Yes U No Method of Shipment- P.ige of <br />