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--I 000 J+iI Vlo LAIVU - MIJIgoI It IIII, Uh J JUJI - k'i11l ) ! !U JUUU - I INA t IUV) /be- UJU0 <br /> N. U 819 Striker Ave , Suite 8 -Sacramento, CA 95834 - (916) 921-9600 FAX (916) 921-0100 <br /> U 404 N Wiget Lane -Walnut Creek, CA 94598- (925) 988-9600 FAX (925) 988-9673 <br /> TOSCO 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 j 4 G 18�_ �f Protect Name 23 -75- --r-Va c y V <br /> Address 0 y :� $R c-rrck C,f: 5-6 i4C -T TOSCO Engineer (required) <br /> City h�b t; n Stale CA Zip Code �Y�B <br /> Telephone qhs_ ss�- �SsS FAX it St r-SS89 Site #, City, Stale ,rr 9 Y T-.ACy Com! v <br /> Report To Dews Lam- Sampler 4- i QC Data )(Level D (Standard) U Level C U Level B U Level A v <br /> .x <br /> Turnaround U 10 Work Days U 5 Work Days �3 Work Days U Drinking Water Analyses Requested a <br /> Time U 2 Work Days U 1 Work Day U 2-8 Hours U Waste Water <br /> CODE; U Misc Detect U Eval U Remed U Demol U Closure Othero�`S a�o� <br /> Client Date/Time Matrix # of Cont Sequoia's �P��h �QP�oti `�P�ti �Qp�o1h \o`�� Vo��`�� <br /> Comments <br /> Sample I D Sampled Desc Coni Type Sample # <br /> 1 ot3S —w 613 /ef NZa 3 VOA5 _L Y LU <br /> s <br /> 2 M,,,r, z ✓ ✓ �/ or <br /> 3 !Aw— 3 DSA—G +'-*" oo' Poo"' <br /> 4 2 <br /> r � <br /> 5 <br /> 6 <br /> 7 <br /> 8 <br /> 9 c� <br /> 10 rr <br /> ar <br /> to <br /> Relinquished By Date 3 Time i}ate Received By Date ,� Time <br /> m <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 Samples on Ice? U Yes U No Method of Shipment Page of <br /> To be completed upon receipt of report <br /> 1)Whe analyses requested on the Chain of Custody reported? U U No It no, what analyses are still needed? _ <br /> 2)W e report issued within the requested turnaround time? U Ye No If no, what was the turnaround time? — <br />