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�r� rr rr rr r rr r _ rr __r r it r rr rr rryy^r r r■r rr <br /> 11 885 Jarvis Drive + Morgan Hill, CA 95037 • (408)776-9600 • FAX (408) 782-6308 <br /> SEQUOIA ANALYTICAL <br /> ❑ 1455 McDowell Blvd, Suite D + Petaluma, CA 94954+ (707)792-9865 + FAX (707) 792-0342 <br /> f CHAIN OF CUSTODY El� 81 D Striker Ave , Suite 8 + Sacramento, CA 95834• (916)921-9600 + FAX (916) 921-0100 <br /> E ❑ 404 N Wiget Lane + Walnut Creek, CA 94598 + (925)988-9600 + FAX (925) 988-9673 <br /> Company Name (, �G++W:wo.�M ProjectDP-no <br /> Mailing Address /q3T 7v Aye_ Billing Address(if different) <br /> City Fl,�tttwk State— Zip Code 3 <br /> Telephone Fax# <br /> PC) # <br /> Report To (,� ��� E-mail Address h� �� � QC Data SLI-evel [I (standard) ❑ Level 111 ❑ Level IV <br /> Sampler Date/Time Results Required Sequoia's Work Order# (z, C) <br /> Turnaround .9_0-15 Working Days ❑ 72 Hours MA DATORY ANALYSES REQUESTED Please orovide method <br /> Time (Standard TAT) ❑ 48 Hours 0 3DWA(Drinking Water) <br /> ❑ 7 Working Days ❑ 24 Hours ❑ WA(Waste Water) <br /> C] 5 Working Days ❑ 2-8 Hours ❑ ICRA(Hazardous Waste) u'' <br /> ❑ ther QIOU,, Q <br /> Client Date/Time Matrix #of Container Sequoia's �0� �� ,n1�d � N Comments! <br /> Sample I D Sampled Desc Conk Type Sample# (ks' TernR Ilf re uired <br /> iG µ,,,,le D�fi�pL <br /> w- 6% OV 14z0 7 <br /> 2 - 7 I✓ <br /> I <br /> 3 M V) -`K, fir HS —13 <br /> 4 [AW-RB <br /> 6 MW - f9L Iop <br /> 7 PAW-kzC 4 <br /> I <br /> i 9 <br /> 10 <br /> a� <br /> Relinquished by/Co / Received y 1 Co Date I Time/Temp q/(/#,( <br /> , <br /> Relinquished by/Co ,6 Receiv8d y 1 Co Date 1 Time/Temp <br /> Relinquished by/Co Received y/Co Date 1 Time/Temp <br /> i Relinquished by/Cc Received Dy/Co Date/Time/Temp <br /> Were Samples Received in Good Condition? t%—Yes ❑ No Samples on Ice'? irk.Yes ❑ No Method of Shipment Page'Z of <br /> White Sequoia Yellow Sequoia Pink Client <br />