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rL � � h eNW Fwd NNW 4F <br /> ❑ 819 West S raker Ave - Sacramento, CA 95834 - (916) 921-9600 FAX (91 1-0100 <br /> CHAIN OF CUSTODY ❑ 1900 Bates Ave , Suite LM - Concord, CA 94520 - (510) 686-9600 FAX (510) 686-9689 <br /> Company Name L %/ L Project Name Ain L5bLc� p L, 10 <br /> Address o _ Wr�p.,�}- Billing Address ( 0 different) <br /> Zip Code � 0Z <br /> City State <br /> C: <br />� <br /> Telephone 0 Z � FAX# �Z 0 ZZ P Q # 5 <br /> Report To OP 44,`` Sam !er Cr 444- CC Data ❑ Level A(Standard) ❑ Level B ❑ Level C ❑ Level D <br /> c <br /> T round 10 Working Days ❑ 3 Working Days ❑ 2 -8 Hours ❑ Drinking Water Ana! ses Requested EL <br /> Time Ys ❑ 2 Wortang Days Waste Water <br /> round <br /> Work ays ❑ 24 Hours Other <br /> 5/ti-� .y <br /> Tient Date/Time Matrix #of Cont Sequoia's V <br /> Sample I D Sampled Desc Cont Type Sample# Comments <br /> 1 ' 13".44S��i �OLD m-L 0 <br /> CT <br /> 2 Ilk <br /> u Z5 <br /> 4 <br /> 5 <br /> 6 <br /> I <br /> 7 0 <br /> Cr <br /> 8 u1 <br /> a <br /> 9 <br /> 10 <br /> Relinquished By Date J •� Time Received By Date LN ime !G l <br /> i <br /> Relinquished By Date 7 / Time /c7 61' Received By IV Date Time <br /> �1 <br /> Rehn wished By <br /> I Date ITime Received By Lab • YVH J. Date• �ime 05 <br /> Were Samples Received in Good Condition? Yes❑ No Samples on Ice? Yes ❑ No Method of Shipment SP�llGl�a Page of�' <br />