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i i <br /> S 01016 i3 885 Jarvis Oriv9*rgsn Hll 1, CA 95037•(4013)776 UM•FAX(408)782-6306 <br /> 10819 StnksrAve,Suite 8*Sacramento,CA 958$4 ■(996)921-0600- FAX(06) 921-UidO <br /> ❑404 N Wrget Lane*Wa1r1Ut Creek,CA 94598*(925)988-9600* FAX(925)965.9673 <br /> ©1455 McDowell Blvd North.Suite D*Petaluma,CA 8495+1*(707)792-1865*FAX(707)792.0342 <br /> TOSC%j y,�, E]1551 Induslrial Mad-San Carlos,CA$407£1*(65Q)232-9600*FAX(650)232.9612 <br /> Consultant Company e T I I RYA IV Tosco EngTneer /� <br /> Address 1 3 6 #�d f 1 f l L`r 1 R I 61d, ter P � Slte#F `l <br /> City � Gt 6 1�, i Stats � Zfp Cade � 7 � Site Address f l 3 �CJ(�i� �f f�,��r ��X14. <br /> Telephon0 07' — Fax # � '� €rrraild rq � y C Clty,State C/ 4V Ir r ',, <br /> c <br /> Report To t 0 ���1` I Sampler �,� � 4C Data �Level D( tandard) ❑Leval C ❑Level B (_�Level A <br /> , - r <br /> 5 Work C7 3 Wotk Dsys E]prinking Water Analyaus Requested <br /> Turnaround 10 Work Days ❑ � Q ❑Was[*Water <br /> Time. [l 2 Work Days ❑ t Work Day U 2.8 HOurS 1 Other 1b <br /> S <br /> crt Coding <br /> O , ' <br /> Client Oatellime Matrix #of COM LM-0- 1 <br /> quoia's Comments <br /> Sample I © Sampled Deco Cont Typemple# Q O <br /> f 3L Y 3 161} - <br /> L <br /> t 3 VV_6 <br /> 3 <br /> Q <br /> 4 _T _ _ — v <br /> 7 - <br /> 4 <br /> 9P 1 <br /> Aehnquishgt)13y _ 08te Yttria: Received 8 Dale } Time _ <br /> Date Time �� Received B Dale Erne <br /> RolrngV[.5hed By — — <br /> Rel�n utsl�ed By Dale 1TIrne Received 13Y 1 Data _Time <br /> Wero Samples Received in Good Colidillon n Yes L]ND SampTes on Ice? r_l Yes U No Method o1 Shipment Page of--- <br /> - - 3 <br /> To be completed upon recelpi OF reporl <br /> 1)Wets the analyses requested on the Chain of Custody reported? Mes LINO If nQ.what analyses are still nBoded) <br /> 2)Was gaze report issued within tho Mquested turnaround time) ❑Yes L]No If no,what was thu trtrdaround bate?__ --- <br /> Approved by _ Signature Company Date _ ,_ <br />