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' GM"wVMRw hIMLY9'!l M9r0 mmff'-` : uLMMH (��b4# t-AMM5) �2.3.3�► . <br /> AIN of cusroov ❑ 819 Strike Suite B Sacramento CA 95834 916 921-9600 FAX 90 <br /> 21-0100 ' <br /> ❑ 404 N WlgdrLane @ Walnut Creels, CA 94598 • (510) 988-9600 FAX (510) 988-9673 <br /> Company Name 5 Project Name. P <br /> Address /03a5," �-- Filling Address(If different) <br /> City. State 64 Zip Code S' <br /> Telephone (?!fj 3Co,:;X -� '/a FAX#_(91r,) 6160 P O # c <br /> LD <br /> -Report To A,-AP Ki-6/0 iSam&r_ 1QC Data, vel D standard ❑ Level C ❑ Level B ❑ Level A V <br /> Turnaround ❑ 10 WorkingDas g y c <br /> y ❑ 3 Working Das ❑ 2 - 8 Hours ❑ Drinking Water Anal ses Re uested a <br /> Time: ❑7 Working Days ❑ 2 Working Days ❑ Waste Water <br /> X5 Working Days ❑ 24 Hours ❑ Other ' <br /> Client Dale/Tlme Matrix # of Cont Sequoia's <br /> Sample I D. Sampled Dose Cont Type Sample# d Comments <br /> 115-0 M—gs- V64 8615 �a asca <br /> 2 a) <br /> 3 <br /> �t e, <br /> j�� <br /> GT o <br /> 4 <br /> 5 <br /> r 1 si ' ass s <br /> 7 r E `s' <br /> s <br /> Cr <br /> �l <br /> Gl <br /> r_+ <br /> 10 <br /> III A I <br /> Relinqulshed By Date 2* Time,/6 3o Received B . Date: zs, y me./630 <br /> Relinquished B t,� Qp Date. ZS, p Time 1760 Recelved By Date, Time, <br /> Relinquished By. Date Time Received By Lab Date a ma• <br /> Were Samples Received In Good Condition?)dYes O No Samples on Ice? A Yes❑No Method of Shipment___5!Pe 6(II( pane J-of �t <br />