Laserfiche WebLink
NO <br /> 0 0 217 5 0 U OOJJdlYIJ L11IVC - mul alI 111111 vn .� njof %-+vvj r rv wvv I"IN %wv) ,v� .+. N, <br /> U r U ❑819 Striker Ave Ab 8•Sacramento, CA 95834* (916) 921-9600 FAX (916) 921-01 <br /> Cd 404 N Wiget Lan alnut Creek, CA 94598 - (925) 988-9600 FAX (925) 988-9673 <br /> Tosco U 1455 McDowell Blvd North, Suite D - Petaluma, CA 94954 - (707) 792-1865 FAX (707) 792-0342 <br /> ❑ 1551 Industrial Road -San Carlos, CA 94070- (650) 232-9600 FAX (650) 232-9612 <br /> Consultant Company GeRlor tkcAn Z ne- Protect Name 141,>3 CL&� I)t-V n o 2480 <br /> Address 6 .y� 5��rrk mak, 5c �- TOSCO Engineer (required) DAVed C�rK i LL <br /> City n t o State Cq Zip Code cjgS6$ 3 3 <br /> Telephone 25) SS!- SSS' FAX # zfJ ss►' 888 Site #, City, State !!Iq� S4«.kfri , CA <br /> Report To nam es Lcx- Sampler A .5'm r f I OC Data 0 Level D (Standard) ❑ Level C ❑ Level B ❑ Level A v <br /> ac <br /> Turnaround IS 10 Work Days U 5 Work Days ❑3 Work Days ❑Drinking Water Analyses Requested r2.L <br /> Time U 2 Work Days U 1 Work Day ❑2-8 Hours U Waste Water Sl gyp, POti�\ P <br /> a� <br /> 6a Off' �Q <br /> CODE: ❑Misc U Detect U Eval U Remed U Demol ❑Closure KOther <br /> Client Date/Time Matrix # of Cont Sequoia's "QPM �`, °gyp \P� ��° Comments <br /> Sample I D Sampled Desc Cont Type Sample # �Q� ��`� �� �Q� Jona ��� <br /> x Mf 13E pY � <br /> 1 Mw -3- Taos 12-112-100 HZ0 ✓QAa EA- 6 � X b <br /> 2 -'ilK t 2)i �oa 1 2- /t�ao l-I ZO s V vq t t7z_ X c <br /> a� <br /> 3 <br /> b <br /> 4 } <br /> 5 <br /> 6 <br /> 7 <br /> 8 <br /> 9 , cc <br /> 0 <br /> 10 (D <br /> U) <br /> Relinquished By Date Time /std Received By Date i iT ea Time <br /> -E <br /> Relinquished By Date ! ^' Time 13,�u Received By Date awff Time / 3� <br /> Relinquished By Date Time Received By Date Time <br /> Were Samples Received in Good Condition? ❑Yes ❑No Samples on Ice? U 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 ❑ 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 />