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% - V V 1'2 4 J u U iJ J1i imuI 11vt7 , ouiku U - oow Cal Iidt 11U, UtA IU) JG i-J000 I r1/1 k. 4U) Je-I-U 0 U <br /> U 404 N Wiget Lane o Walnut Creek, CA 94598 • (925) 988-9600 FAX (925) 988-9673 <br /> jC)SW (jpocAL U 1455 McDowell Blvd North, Suite D - Petaluma, CA 94954 • (707) 792-1865 FAX (707) 792-0342 <br /> U 1551 Industrial Road • San Carlos, CA 94070• (650) 232-9600 FAX (650) 232-9612 <br /> Consultant Company i� 6._ L� Protect Name -i�l E �t/�(„ S - <br /> Address b Z4� �)e TOSCO Engineer (required) mock fJ,L&4S:;Pn <br /> City - plJ� 1 — SateCA <br /> Zip Code !!L sb <br /> Telephone qZ `SSS --7 o5ss FAX # C7ZS�I Site #, City, State 1 S7 _ S - - - C <br /> Report ro + <br /> p Sampler QC Data U Level D (Standard) U Level C U Level B - U Levet A U <br /> Turnaround U 10 Work Days5 Work Days U 3 Work Days U Drinking Water Analyses Requested <br /> Time U 2 Work Days U 1 Work Day U 2-8 Hours Ll Waste Water &N FAQ n <br /> �� 0ti 0`L <br /> y� S <br /> CODE. U Misc U Detect U Eva! U Remed U Demol U Closure U Other o1h 00�0� o\ o1y�oa°��� \` p <br /> Client Date/Time Matrix # of Cont Sequoias �P0 AQP \QP QP0 0` o�� <br /> Sample I D Sampled Desc Cont Type Sample # Comments <br /> gyp_ I Z t z z <br /> 6 S .-oq�o 0 <br /> _ Cr <br /> 4 <br /> 5 +�-Zv-- — '1 > <br /> 7 <br /> 8 <br /> g ---- - <br /> 10 i - ° <br /> —-- w <br /> Helinquished By Date l 1 3 ai Time /3.;S- Received B fNate 1)11,)�A Time <br /> Relinquished By -- Date Time Received By Dale Time 3: <br /> Relinquished By Date Time Received By Date Time <br /> Wore S,oripir s 13eceived in Good Condifion? U Yes U No Samples on ice? U Yes U No Method of Shipment__ Page of <br /> To be completed upon receipt of report <br /> 1) Were the analyses requested on the Chain of Custody reported? JAYes U No It no, what analyses are still needed? <br /> 2) Was the report issued within the requested turnaround time? If no, what was the turnaround time?} t� _ <br /> Approve _ _ - �— Signature _-- Company /C - -- - 717 01 <br />