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J 88b Jaivis Uiive - Mutgan Hill, (,A 9bUJi - (4U8) r ib-9bOU - FAX (,TUB) 182 6JU8 <br /> N1111 001170 X819 Striker Ave , Suite 8 - Sacramento, CA 95834 - (916) 921-9600 FAX (916) 921-0100 <br /> uU 404 N Wiget Lane -Walnut Creek, CA 94598 - (925) 988-9600 FAX (925) 988-9673 <br /> 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) 2322-X9^600 FAX (650) 232-9612 <br /> Consultant Company a Project Name _s r- -rest _ <br /> Address Zq7 1�-,'per�.a L�t� TOSCO Engineer�(required) �1 LV 1& _ <br /> City — - V� �1iK State CA Zip Code Y5 z8 It3 ! E- , M I KV St - tTelephoneaZg-- S5!- ?SS'S FAX # �ZS'_S5!_ 78$8 Site #, City, Slate 0167 C>�G�� lA <br /> —Re — <br /> eport To Ep � t- Sampler WU KA&f OC Data evel D (Standard) U Level C U Level B U Level A <br /> Y <br /> Turnaround U 10 Work Days5 Work Days U 3 Work Days U Drinking Water Analyses Requested 9 <br /> Time U 2 Work Days U 1 Work Day U 2-8 Hours �, <br /> U Waste Watereti� � <br /> CODE U Misc U Detect U Fval ARemed U Demol U Closure ❑Other <br /> Client Date/Time Matrix # of Contt 5equoia's ��� �� ���EaP�Q��eP� Comments <br /> Sample I D Sampled Desc Cont Type Sample # <br /> 1 Ill --1-zZ 51461- W4u' Z VOA X x X �t <br /> 211fP[-b .5' X }< K <br /> 3A) -1- 111 X X X - <br /> 5IVP2.- 20 X X <br /> -6 �1 -z 60 X x X _ <br /> 7 -Z- 116 aC X x -- <br /> a — -- <br /> 9 nr _ co ' <br /> 10 <br /> 1 U) <br /> Relinquished By Date 6 dl Time 155-5 Received s We ( Time <br /> Relinquished By Date Time Received By Date Time <br /> Relinquishe,t By Date Time Received By Date Time <br /> Were Samples Received in Good Condition? U Yes ❑ 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? U Yes U No If no, what analyses are still needed? <br /> App*Was the report issued within the requested turnaround time? as 0 No if no, what was the turnaround time? <br /> .by Signature Company . __bate __ <br />