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I <br /> O L'1885 Jarvis drive rgan Hill, CA 95037 @ (408)77$-9600• FAX (408)762-6308 <br /> 2370 4,919 Striker Ave, .e 8•Sacramento.CA 95534•(916) 921-9600 FAX(915)921-0100 <br /> U 404 N Wiget Lane•Walnut Cra9k, CA 94698 • (925)988-9600 FAX(925) 988-9673 <br /> ❑ 1455 McDowell Blvd North, Suite D•Petaltuma,CA 94954 ■(707) 742-1855 FAX(707) 782-0342 <br /> TOSCO U 1551 Industrial Road•San Carlos, CA 94070•(650)232-960D FAX (650)282-9612 <br /> Consultant Company Go"r'- j�/ NG Project Narn© f nm r• 1";&�;c o �j � 'If <br /> AddressO { Cq A7 go /` r T[�SC Engineer(required) �� <br /> City ganba-- � state 4 TSP Code- q56 70-j-6i t to r�L it', 0 <br /> Telephone 0(6 31�" j ff f PAX#j /�)of-131 7 Site 0,City.Slate } 5-hrG rt IVA11 4q f,'(IF <br /> Y - <br /> Report To: Vp cp51>Cpf' I Sampler. 6,6, jib QC Qata• ❑Lavol D(Standard) U Level C Level B ❑Level:A <br /> � <br /> Turnaround to Work Days Q 5 Worts Uays 3 Work Days ❑Drinking Water Anatynes Requested � <br /> Timor D 2 Work Days t]Mo&Day U 2-8 Hours ❑Waste Water oma <br /> CODE: U mFsc U Dotcei ❑Eval 0 Remed ❑Demo] ❑Closure I ❑Other IF, +s ` <br /> Orient t7atelTme Matrix #of Cont Sequola"s. � c Comments <br /> Sample I D Sampled De so Cont Type Sample# <br /> 1. AAVV- 76 00,40 <br /> a <br /> 3 _ <br /> 3. <br /> 4 <br /> 4. <br /> & <br /> 7. <br /> 9. <br /> Cr <br /> to � <br /> ivod al. <br /> UL Time. i a.?Date: Time Re <br /> Rellnqulshed By r_ f `' - <br /> Rolinquished By Date- Time. _ Received By. Date Time <br /> Relinquished By. Date Time Received By Date Time <br /> Were Samples Received in Good Condihvn? UYas ONO Sanrpres on lee) ❑Yes t3 Flo Method of Shipment Page_of <br /> To be completed upon receipt of report <br /> 1)Wena (lie analysos requested on the Clain of Custody reported? s L)leo If no,what analyses are still needed? <br /> 2)Was the report issued within requested turnaround time? Yes ©N!..,x <br /> what was the turnaround time? <br /> Approv c.., �_• oS�_ — EQndture. Company (3-_ - Date 2�a'Z <br />