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t l l�V Nt� LJ � QUO.salvia v4wv - ivwlyaIi IM1, v— k—vv- . .v v--- % --I <br /> ❑ 819 Striker Ave�ite 8 - Sacramento, CA 95834- (916) 921-9600 FAX (916) 921-0 <br /> X,404 N Wiget L Walnut Creek, CA 94598 - (925) 988-9600 FAX (925) 988-967 <br /> U 1455 McDowell Blvd North, Suite D -, Petaluma, CA 94954- (707) 792-1865 FAX (70 792-0342 <br /> TOSCO <br /> ❑ 1551 Industrial Road - San Carlos, CA 94070- (650) 232-9600 FAX (650) 232-9612 <br /> )Consultant Company � .G-fZ — ] N Project Name l (.� <br /> Address 6"I 5���� �— �- J TOSCO Engineer{required) <br /> City L %rJ State Zip Code V <br /> Telephone `� ! .. ��5 FAX # Site #, City, State <br /> v <br /> Report To Sampler �,� � N�p S� QC Data Lp" vel b (Standard) U Level C ❑ Level B U Level A , <br /> Y <br /> c <br /> Turnaround >kia Work Days U 5 Work Days ❑3 Work Days ❑ Analyses Re uestedDrinking Water Y q a <br /> Time U 2 Work Days U i Work Day ❑2-8 Hours U Waste Water <br /> CODE: ❑Misc Aetect © Eva[ U Remed U Demol U Closure OtherClient Date/Time <br /> ix # of Cont Sequoia'sPCO QP" <br /> Sample I D Sampled Desc Cont Type Sample # P � � �P \� �� Comments <br /> 1 9K 12'1 Z <br /> NbN -0 -� T3 <br /> 0 <br /> _� Q) <br /> 2 w�3- o Cr <br /> 3 3 <br /> 0 <br /> 4 } <br /> 5 <br /> 6 <br /> 7 <br /> 8 <br /> m <br /> 9 o <br /> 10 a <br /> Relinquished By Date r Time Received By �, Date Time <br /> t <br /> Relinquished By Date z{ Time/3p,f� Received By Date Time <br /> Relinquished By Date Time Received By G Date Time 13 QS <br /> Were Samples Received in Good Condition? U Yes U No Samples on Ice? ❑Yes ❑ No Method of Shipment Page_of <br /> To be completed upon receipt of report <br /> 1)Were the analyses requested on the Chain of Custody reported? ❑Yes 0 No If no, what analyses are still needed? <br /> 2)Was the report issued within the requested turnaround time? ❑Yes ❑ No If no, what was the turnaround time? <br /> Approved by Signature Company Date <br />