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g:JVEQUOIA ANALYTICAL El C3 <br /> McDowela North, Suite D • Petaluma, CA 94954• (707) 792-1865 • FAX 0 792.0342 <br /> C3819 Striker Avem,Kite 8 • Sacramento, CA 95834• (916) 921-9600• FAX (916) 92 0 <br /> CHAIN OF CUSTODY ❑ 1551 Industrial Road•San Carlos, CA 94070• (650) 232-9600 • FAX (650) 232-9612 <br /> ❑ 404 N Wiget Lane •Walnut Creek, CA 94598•(925) 988-9600• FAX (925) 988-9673 _ <br /> Company Name p� �` �� Protect A <br /> Mailing Address J 5 re cn 1Y Z Billing Address (d different) <br /> City n�``�r 11 State L N- zip Code Q aC-11 U <br /> Telephone d 7.�-a 7SS Fax# PO # v <br /> Report To pv1Ux- Le Vi 4C E-Mail OC Data O Level it (Standard) ❑ Level Ili ❑ Level IV <br /> Sampler ,, Pl Date/Time Results Required Sequoia's Work Order# l a?—:3 rz <br /> Turnaround 2( TO- 15 Working Days ❑ 72 Hours MANDATORY <br /> ANALYSES REQUESTED (Please provide method) <br /> Time. (Standard TAT) ❑ 48 Hours ❑ SDWA(Drinking Water) <br /> ❑ 7 Working Days ❑ 24 Hours ❑ CWA(Waste Water) <br /> ❑ 5 Working Days 0 2-8 Hours ❑ RCRA(Hazardous ase) `�� Commence <br /> a Other We'rM.L�h � ` /Q Temp(it regwrod) <br /> Client Date/Time Matrix #of Container Sequoia's <br /> Sample I D Sampled Desc Cont Type Sample# _ <br /> 1 <br /> yu �vrL v i I 0���� 4'C- ^��E D <br /> a <br /> gdMLV(� Dom- <br /> 2 - 3' S� c,ti1 <br /> o <br /> 3 W -2 w LJ M t-,/c,�• 03 1C Y� <br /> 4MVV_ ' Z 16 ") vJ 3 ( 04 <br /> 0 <br /> 6 <br /> c <br /> m <br /> 7 <br /> 3 <br /> 9 <br /> 10 <br /> Relinquished By Received By , , , Date I Time <br /> h4 <br /> Relinquished <br /> Relinquished By Received By Date/Time <br /> Relinquished By Received By Date/Time <br /> Relinquished By Received By Date/Time <br /> Were Samples Received in Good Condition? 0 Yes 0 No Samples on ice? ❑ Y9 0 No Method of Shipment____ Page---I of <br />