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w L"R`�A" NW 5t�gve a ti Mram=GAM4 • �921PW F�t6) X100 M <br /> /`'� LI 404 N Wigel l_ WaEnut Creek, CA 94598 . 925) 988-9600 FAX (925) 988-967 <br /> HA[N OF CUSTODY LI 1455 McDowell North, Suite D • Petaluma, CA 94954 • (707) 792-1665 FAX (7 92 0342 <br /> Q 1551 Industrial Road • San Carlos, CA 94070 • (650) 232-9600 FAX (650) 232-9612 <br /> Company Name ProjectName <br /> Mailing Address 3 Billing Address (if different) <br /> City U> �- State CA- Zip Code .� <br /> Telephone y _ q `G SZ FAX # _ rU PO # <br /> 36* <br /> Report Tom,--� � Sampler OC Data vel D (Standard) U Level C U Level B U Level A <br /> x <br /> Turnaround x440 Working Days L7 3 Working Days L7 2-8 Hours U Drinking Water Analyses Requested <br /> CL <br /> Time U 7 Working Days ❑2 Working Days 05AUpsle Water <br /> U 5 Working Days L1 24 Hours Other <br /> Client Date/Time Matrix # of Cont Sequoia's �q /� Comments <br /> Sampte I D Sampled Desc Cont Type Sample # <br /> tom5 <br /> - o <br /> a <br /> 6 <br /> 2 <br /> 3 <br /> a� <br /> 4 -2S- oy 2,9 L- ✓ r <br /> 5 %30 j S <br /> 6 3� • sz <br /> 7908 s <br /> Cr <br /> 8 <br /> ad�ILz � <br /> _9 _ 15V r <br /> 10 (��SZ /Y-�C �w l� R Mi► � r X TtsT � � � <br /> /Ov0 Wa�ry 3 d <br /> Relinquished By �j„µ� Date %1Y1S Time 1jSP Received By L Date i,t <br /> Relinquished By '�— - Date,/ Ire Time le!V Received B ( ate tZ (S�t Time (41 qq- <br /> Relinquished By Date Time Received By Date Time <br /> Were Simples Received in Good Condition? U Yes U No Samples on Ice? U Yes U No Method of Shipment. Page of <br /> 4 <br />