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dITUM <br /> ANALYTICAL 885 Jarvis Dnv organ Hill, CA 95037 • (408) 776-9600 • FAX (408) 782-63084r <br /> 13 1455 N McDo Blvd, Suite D • Petaluma, CA 94954 • (707)792-1865 • FAX (707) 792-0342 <br /> RAIN OF CUSTODY ❑ 819 Striker Ave , Suite 8 • Sacramento, CA 95834• (916)921-9600 • FAX (916) 921-0100 <br /> ❑ 404 N Wiget Lane ® Walnut Creek, CA 94598 • (925) 988-9600 • FAX (925) 988-9673 <br /> Company Name�j gA�'3 n,�, psa, Protect <br /> Mailing Address <br /> 6'7�� f9r //�-*61v Billing Address (if different) <br /> City QState CA Zip Code 9Szo3 <br /> Telephone.-530 923.-z,q;, Fax# PO # <br /> Report To�� E-mail Address c 6) QC Data Level II (standard) ❑ Level III ❑ Level IV <br /> Sampler � a.�� Date/Trme Results Required Sequoia's Work Order# <br /> Turnaround )K 10-15 Working Days ❑ 72 Hours MANDATORY. ANALYSES REQUESTED Please provide method <br /> Time (Standard TAT) ❑ 48 Hours ❑ SDWA(Drinking Water) <br /> ❑ 7 Working Days Cl 24 Hours q CWA(Waste Water) i <br /> ❑ 5 Working Days ❑ 2-8 Hours RCRA(Hazardous Waste) <br /> ❑ Other A� <br /> Client Date 1 Time Matrix #of Container Sequoia's C' <br /> Sample I D Sampled Desc Cont Type <br /> Sample# Comments/ <br /> 2S-VW/ Tem if required) <br /> 2 .�� <br /> 3 2�/3 <br /> 4 <br /> 6 <br /> 7E'y^ 3 <br /> 8 x <br /> 9 es-W <br /> 10 w --70 <br /> Relinquished by 1 Coi Received by 1 Co a Date/Time 1 Temp IIA-7116,1 12.fg <br /> Relinquished by I Co Received by/Co Date 1 Time 1 Temp <br /> Relinquished by 1 Co Received by I Co Date 1 Time 1 Temp <br /> Relinquished by/Co Received by 1 Co Date I Time 1 Temp <br /> Were Samples Received In Good Condition? 7P Yes ❑ No Samples on Ice? ?0 Yes ❑ No Method of Shipment Page I of_�_ <br /> White Sequoia Yellow Sequoia i q Pink Client <br />