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• ❑ 885 Jarvis Drive - an Hill, CA 95037• (408) 776-9600 • FAX (405) 752-63060 <br /> V 008331 p 8i9 Striker Ave , S e 8 • Sacramento, CA 95834- (916) 921-9600 • FAX (916) 927-01 J111111%,0 � <br /> ❑404 N Wlget Lane •Walnut Creek, CA 94598• (925) 988-9600 • FAX (925) 988-9673 <br /> iL AF—IU <br /> ❑ 1455 McDowell Blvd North, Suite D • Petaluma, CA 94954 • (707) 792-1865 • FAX (707) 792-0342T0%R%0 _ <br /> ❑ 1551 Industrial Road • San Carlos, CA 94070• (650) 232-9600• FAX (650) 232-9612 <br /> Tosca Engineer` <br /> Consultant Company � <br /> Andress Site# <br /> City State . Zip Code Site Address �, C <br /> Telephone 1�`� Cit State <br /> _M � U <br /> P ) - `'� a - " �� QC Lr 71 D (Standard) p Level C ❑ Level B ❑Level A <br /> Report Tcf Sampler <br /> C_ <br /> Turnaround 10 Mork Days ❑ 5 Work Rays :13 Wort,Days J Drinking Water Analyses Recluesteci 0_ <br /> Time ❑ 2 Wortc Days Zl 1 Work Day U 2-8 Hours j waste Water <br /> Other <br /> Project Costing c?, 0 55 Q TI -7 <br /> Client Dateffime Matrix # of i Cont Sequoia`s ���� �� "� �� � f � Gi�i�rrTients <br /> 5arnole I D Sampled Desc Cont Type Sample <br /> i -- _ __ �_- _ 5 <br /> to <br /> 5 � m <br /> 6 1 <br /> r <br /> 7MWERA - I - <br /> �i <br /> _ I <br /> t <br /> Relinquished By Gate ) Time 192 Received y,., 4 t �'r _ 7 1 M e ' <br /> Relinquished By Date Time _ Received B C3ate Time e&K', <br /> Relinquished B Date Time i Roived B Date Time <br /> Were Samples Received in Good Condition) ❑ Yes ❑ No Samples on Ice? ❑ Yes ❑ No Method of Shipment Page of <br /> To too co ripletet upon receipt of report <br /> t)lVere ttie analyses requested on the Chain of Custody reported? ❑Yes ❑No If no,what analyses are still needed? <br /> 23 Wnn the report issued within the requested turnaround time) ❑Yes p No If no,what was the turnaround time? <br /> Ippsr>rsrrf by <br /> Signature Company Date <br /> r — <br />