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1 u bbb Jarvis Urive • Morgan Hill, UA 9bUJ/ • 4083 /`b-9600 • FAX 408 782-6308 <br /> ❑819 Straker Ave 8 Sacramento CA 95834 (916) 921-9600 FAX (916) 921-01 <br /> ft <br /> Tosco ❑ 404 N Wigef La alnut Creek, CA 94598 • (925) 988-9600 FAX (925) 988-9673 <br /> © 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 CompanyGclflr-r -�v,c Project Name 3�S L V ra 1410187 O <br /> Address TOSCO Engineer (required) <br /> Sicrr�. �� c u," c.� t•,n � � <br /> City ��b State Zip Code 71/5- 6 <br /> Telephon S _- FAX # �'�15 55'x` Site #, City, State 11194rc,� /-� _z <br /> Report To Sampler S i QC Data XLevel D (Standard) ❑ Level C ❑ Level B u Level A U <br /> Y <br /> Turnaround X1.10 ork Days ❑5 Work Days ❑3 Work Days ❑Drinking Water Analyses Requested <br /> Time ❑ 2 Work Days ❑ 1 Work Day ❑2-8 Hours & t/ a <br /> ❑Waste Water V <br /> OP Qp 2Q ` <br /> CODE' ❑ Misc Q Detect ❑ Eval ❑ Remed ❑ Demol ❑Closure O�Other �c� <br /> # ti�\ <br /> Clie Date/Time onuo \,itiCtrlL\�� <br /> CommentsSap I D Sam led Desc Cont Type Sample <br /> �Q �o i✓ <br /> 1 C2 Db - 5 V/vA S rX ul13� t- v <br /> X � 13�`L X�'at 8260 ns <br /> 0 <br /> 2 I [-�}mob x Cr <br /> 500 AL PL a)C <br /> 3 w HNO3 x <br /> 5o M 1L L 3 <br /> 4 ►�' I�aVy o <br /> 5 <br /> KL L x } <br /> 6 <br /> 7 <br /> 8 <br /> 10 Do Mo incladc <br /> a) <br /> Relinquished By Date�z Time d Received By Date 1 �S ,� Time lla� n, <br /> a) <br /> Relinquished By k Date �� �� Time 1530 Received By Date 011Time 3� <br /> i <br /> Relinquished By Date Time Received By Date Time <br /> Were Samples Received in Good Condition? ❑Yes ❑ No Samples on Ice? ❑Yes ❑ 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? ❑Yes ❑ No If no, what analyses are still needed? <br /> 2) Was the report issued within the requested turnaround time? ❑Yes ❑ No If no, what was the turnaround time? <br /> Approved by Signature Company _ __ _ Date _ <br />