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u o0o adrws urive • Morgan )tui, UA VbUJ/ • (4U21) !1b-9bUU& t-AA (4Ud) 182-bJU8 <br /> 0 <br /> 001171 W819 Striker Ave , Su • Sacramento, CA 95834 • (916) 921-9600 FAX (916) 921-0100 <br /> U` ���� C3404 N Wiget Lane • nut Creels, CA 94598• (925) 988-9600 FAX (925) 988-9673 <br /> J%GM �J 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 x1C. Project Name S� <br /> Address 67 q-7 .5jerf s_ Su�T-� TOSCO Engineer (regwred?. + P.lS4n <br /> Citypub 1i 1M1 State Zip Cade �T�6 �� U Ker 5t <br /> Telephone -'j" -757S5-X I}(i FAX # Site #, City, State 5-6G ax <br /> Report To -pool Les-6WK44,f Sampler �� � )tilt - OC Data *eve] D (standard) ❑ Level C U Level B U Level A U <br /> Turnaround U 10 Work Days JC5 Work Days ❑3 Work Days U Drinking Water Analyses Requested <br /> Time U 2 Work Days U 1 Work Day U 2-8 Hours �o� o� <br /> O Waste Water �� �ti �ry� <br /> 14,11 <br /> CODE: U Misc U Detect U Eval D Remed U Demo! U Closure U Other opo, <br /> Client Date/Time Matrix # of Cont Sequoia's �P� `P� <br /> Sample i D Sampled Desc Cont Type Sample # 1Q�` ��`�� ���� �Q� �o\���� ���`� Comments <br /> l�P r 2 Z _ sdt• Sao G VbA X X << <br /> 2 tjP - 6S -Mo X X X C <br /> :t <br /> 3 Pp-I-J X x -b <br /> 4 _ o <br /> 5 N 2- ZD <br /> 7 Toto x x <br /> 8 <br /> 9 <br /> 10 Cr <br /> m <br /> U) <br /> Relinquished By 40 ItDate 5'Dl Time Q Received BVJQfVCafaa#e S Time ILI a� <br /> Relinquished By Date Time Received By Date Time <br /> Relinquished By Date Time Received By Date Time <br /> Were Samples Received in Good Condition? U Yes U No Samptes on lce? U Yes U No Method of ShipmentPaye of <br /> To he compteted upon receipt of report <br /> 1)Were the analyses requested on the Chain of Custody reporled9 U Yes U No If no, what analyses are still needed? <br /> 2) Was the ieport issued within the requested turnaround time? U Yes U No If no, what was the turnaround times <br /> Appiovud by — _ _ _ _ Signature __ _�_ __ __ Company _-- - _ fate <br />