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• <br /> 44D AkUOIA ANALYTICAL 11885 Jarvis Drive Hill, CA 95037 • (40$} 776-9600 FAX (408) 782-630$ <br /> 1 ❑ 1455 McDowell Blvd, Suite D * Petaluma, CA 94954 * (707) 792-1865 * FAX (707) 792-0342 <br /> �� CHAIN OF CUSTODY !KL 819 Striker Ave , Suite 8 * Sacramento, CA 95834 * (916) 921-9600 * FAX (916) 921-0100 <br /> I ❑ 404 N Wiget Lane * Walnut Creek, CA 94598 * (925)988-9600 * FAX (925) 988-9673 <br /> Company Name 7jZo.ac ,,,,, "'�, ,4 , J.I Project - F (, 1,4 v( ,F v <br /> Marling Address ) kr�% I A,0 Billing Address (if different) <br /> City i�1,4P .�, I State r\�-r_ Zip Code T-17-,,D3 <br /> Telephone (6v7)'7"z Fax# irr„Z��zs P-0 # <br /> Report To W,�r{/, I E-mail Address �t� ,{ r, QC Data la Level II (standard) ❑ Level ill ❑ Level IV <br /> Sampler �� �1, j Date 1 Time Results Required Sequoia's Work Order# <br /> Turnaround - 10-15 Working Days I ❑ 72 Hours MANDATORY ANALYSES REQUESTED Please nrovide method <br /> Time (Standard TAT) I ❑ 48 Hours ❑ SDWA(Drinking Water) <br /> Q 7 Working Days ❑ 24 Hours ❑ CWA(Waste Water) <br /> ❑ 5 Working Days I ❑ 2-8 Hours Cl RCRA(Hazardous Waste) J T` <br /> ' ❑ Other <br /> � cr <br /> Client Date/Time Matrix #of Container Sequoia's \,! ` Q <br /> i_ Comments/ <br /> Sample I D Sampled Dose Cant Type Sample # Temp(If required) <br /> IT3 ll/0A <br /> S-v <br /> I 1 <br /> 3 11i(A) <br /> i <br /> 4 <br /> 5 <br /> 6 <br /> 7 <br /> 8 l�W /-7 <br /> 9 1v (v t7C / 140 i 9 <br /> 10 ,,�1V- �T5 ��r�ivS -� 14 <br /> NY <br /> 1 41 11 <br /> Relinquished by/C ku�ri*►' eceived by 1 Cl = ��'- _` Date 1 Time 1 Temp II }�� �- <br /> Relinquished by 1C Received by 1 Co U Date 1 Time/Temp <br /> Relinquished by 1 o U Received by 1 Co Date 1 Time 1 Temp <br /> Relinquished by 1 Co Received by 1 Co Date 1 Time 1 Temp <br /> Were Samples Received in Good Condition? ❑ Yes ❑ No Samples on lee? ❑ Yes ❑ No Method of Shipment Page ( of Z <br /> White Sequoia Yellow Sequoia Pink Client <br />