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wiii� 111111111110111111 1111P11111111111111 <br /> 4D UOIA ANALYTICAL ❑ 885 ,Jarvis Dnve0organ Hill, CA 95037 + (408) 776-9600 • FAX (408) 782-6308 <br /> ❑ 1455 McDowell Blvd, Suite D • Petaluma, CA 94954 • (707) 792-1865 • FAX (707) 792-0342 <br /> 1W CHAIN OF CUSTODY /6 819 Striker Ave , Suite 8 • Sacramento, CA 95834 • (916) 921-9600 + FAX (9 16) 921-0100 <br /> I ❑ 404 N Wiget Lane • Walnut Creek, CA 94598 • (925) 988-9600 • FAX (925) 988-9673 <br /> Company Name ~-car +�,�. Project (,- X14 J ,f-7m, --� <br /> Mailing Address I fn /v Billing Address (if different) <br /> City -j77/WL,, ). j State Aj Zip Code 7;cry <br /> Telephone{ 6na 77ZS-00?r r7 1 f Fax# c 1-17 1-7 z a_ -, 7A, P O # <br /> Report To '->�-t,c l�cG, �_ ` E-mail Address 7,-1 _, i 0,,% �r _ QC Data Level II (standard) ❑ Level III ❑ Level IV <br /> Sampler /„� , l Date 1 Time Results Required Sequoia's Work Order# <br /> Turnaround ES-110-115 Working Days ❑ 72 Hours MANDATORY ANALYSES REQUESTED Please orovide method <br /> Time (Standard TAT) I ❑ 48 Hours ❑ SDWA(Drinking Water) <br /> ❑ 7 Working Days ❑ 24 Hours ❑ CWA(Waste Water) <br /> ❑ 5 Working Days I ❑ 2-8 Hours ❑ RCRA(Hazardous Waste) <br /> a ❑ Other <br /> Client Date 1 Time Matrix #of Container Sequoia's Comments/ <br /> Sample I D Sampled Desc Cont Type -Sample # lf� Temp(If required) <br /> L A,"1rr <br /> 9 ?� <br /> /�i�� <br /> 2 4 ��-`7C t r-7 TO <br /> I l � <br /> 3 (yf IU r( ��►wr'3 g ,p <br /> y <br /> 5 A w- l oc <br /> 6 <br /> 8 <br /> 9 <br /> 10 <br /> Relinquished b u, f` AI/' Received by 1 Co, Z �_i� c- Date 1 Time I Temp y 1) UJ <br /> Relinquished by o Received by 1 Co Date 1 Time 1 Temp <br /> Relinquished thl Co Received by 1 Co Date 1 Time/Temp <br /> Relinquished by 1 Co Received by 1 Co Date/Time 1 Temp <br /> Were Samples Received in Good Condition? ❑ Yes ❑ No Samples on Ice? ❑ Yes ❑ No Method of Shipment Page Z of 7— <br /> White <br /> White Sequoia Yellow Sequoia Pink Client <br />