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r1n t..� ..�... �• <br /> ! l 0680 Chesapeake Drive Redwoo City, A 94063 364- 39 1 e, ite 1 t e <br /> ❑ 819 Striker Ave,Suite 8•Sacramento,CA 95834-(916)921 9600 ❑ East 11115 Montgomery,Suite i3•Spokane WA 99206-(5 4 9200 <br /> EVQ 404 N Wiget Lane•Walnut Creek,CA 94598•(510)988 9600 Q 15055 S W Sequoia Pkwy Suite 110•Portland,OR 97222•(503)624 9 <br /> 800 <br /> Consultant Company 1 ho in V Project Name 31 H 14 16- <br /> Address , &NGHGAL Project Manager DQ ` , ( � S JQ Z 7 -�- <br /> Slate Zip Code 9S1d AFE # m <br /> City OSZ _ <br /> Telephone 408- 44 1-757 a FAX # '75 3 Site #, City, State Stl�-l� S1 S 1 v <br /> QC Data Level D (Standard) ❑ Level C ❑ Level B ❑ Level A c <br /> Re ort To _ rn V Sam ler � d <br /> Turnaround 1 10 Work Days ❑ 5 WQork��ayZ y❑tsfWco�rrk Day ❑ Drinking Water Anal ses Re uested r Z <br /> t o trW iJ 2 t1 Fi <br /> Time ❑ 2 Work Das ork Da ours ❑ Waste Water ,mak <br /> CODE- ❑ Misc ❑ Detect Id Eval ❑ Remed ❑ Demol ❑ Closure I ErOlher <br /> Client Date/Time Matrix # of Cont Laboratory �XComments <br /> Sample I D Sampled Desc Cont Type Sample# Z, <br /> 0 <br /> �{t: e W <br /> +Z {2 5 W194,zO 8 <br /> J <br /> 13D-3 o0 oKy9 a o <br /> Abo <br /> us <br />�,s�o 2 3 �� t ► > t? <br /> 2 <br /> 7 ,5b ryn <br /> STS <br /> - <br /> pp--z I.zs x o <br /> lit <br /> o PP-3 � <br /> "Ime Date z r TimeRelinquished ByDateReceived B �t�C� Datedll7 C�' TimeRelinquished By Date Received B171 n� Timen Received B Lab Date <br /> Relin uished B (►rod Dat Z-1. a� !t z <br /> QQ��� ��,,., t y�� // ' ? Pae of <br /> et aona Os ecePe'd Condit ort ❑Yes U No Samples on ice 1-1 Yes�� No Method of 9 <br /> be completed upon receipt of report <br /> hain of Custody <br /> �1 reported? O Yes V No If no, what analyses are still needed? <br /> Were the analyses requested on the C <br /> time? ❑Yes❑ No if no, what was the turnaround times <br /> Was the report issued within the requested turnaround _ <br /> Signature � -- _Company _—��__ __--__-.---_� __ Date — <br /> by - —-- <br />