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❑ 886 Jarvis Dave- Mcrgarf Hill, CA 98037 • (406) 776-9600- FAX(4013) 782.6308 <br /> N° 007528 C)819 Striker Ave ,Suite 01 Sacramento,CA 95534 (9iB�92i soo* FAX (916)1921-0100 <br /> p 404 N Wlget Lane•Walnut Greek,CA 54596 - (925) 988 9600 - FAX(925)988-9673 <br /> 9.1455McDowell Blvd North. Suite D- Petaluma, CA 94954 • (707) 792-1865 - FAX(707) 792 0342 <br /> Tobuu ❑15561 Industrial }load • San Carlos, CA gd070 • (650) 232-9600 ■ FAX(650) 232-9612 <br /> Consultant Company 6r�'• Q,J" ate,- Tose Engineer <br /> Address 13b� A? ti`1�10�vr�� t0l �y+,1�. 9j,:>- � Site#' -L <br /> City. Au%tiuy.. StateCA Zip Code 94l5Site Address J03vur <br /> Telephone Fax#-- "Tp y• - City,State 4 <br /> r?i�l: �g� 3'7:�� _ '�'Z1� �6k6n CA <br /> Report To f Sampler QG Data Loval D (Standard) 0 Level C p Levol B u Level A c <br /> Turnaround 10 Work Days f ❑ 5 Work Daya ❑ 3 Work Days Cl Dunking Water Ar>•atpes Requested a <br /> limo, v 2 WOFk Days ❑ 3 Work day l.t 2 8 Hauls C] Waite Water � <br /> - — U Other' <br /> Protect Coding — <br /> Client Date/Tirlie Matra #I of Coni Sequola's �� �.�� '�° a��"�O '�� � Comments <br /> Sample I D Sampled peso Cont Type Sample# <br /> ' _ xr <br /> 3 Xv• j�3, rf OL _1�.4,a _ Q��t41�.1 _ 6 <br /> 4. <br /> 7 4-14 <br /> Y <br /> Ralfnqulshed 8y Data IL TImB 0 Received By, Date !2 Time X7 7 <br /> Relfnqulshed date _ _ Time Received B , dale Time. <br /> B ❑ate Time 80cofve"Y — <br /> RelinquishedDa#�{ Tim , <br /> Wert/Samples Received is Goad Condition? Yes ❑ iso Samples un Ice? JR Yes C1 No Method of Shipmont -)&, <br /> Page r of <br /> To ho completed upon recelpt of raport <br /> 1)Were tha anafysm requested on the Ohafn of Custody reported? )Ayes [J X10 I I na,what anafysos are stJl needed? <br /> 2)Was tho report issued m Irl U1 a rortcosled turnaround trm el Q Yes talo na,Whal Was lho lumaround time?r �'�� <br /> Company Signature Date <br /> 1pprnyedb <br />