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. <br /> Udo,)JdI Via UIINOU • IVIU,9wI , nil, y .r L JdVi <br /> V-1 U U 2 8 5 b O 819 Striker Ave , Suite 8 - Sacramento, CA 95834• (916) 921-9600 FAX (916) 921-0100 <br /> K404 N Wiget Lane•Walnut Creek, CA 94598• (925) 988-9600 FAX (925) 988-9673 <br /> ❑ 1CA 94954• (707) 792-1865 FAX (707) 792-0342 <br /> SCO <br /> 455 McDowell Slvd North, Suite D• Petaluma,TU ❑ 1x551 Industrial Road - San Carlos, CA 94070• (650) 232-9600 FAX (650) 232-9612 <br /> 111 l u G <br /> (nIP <br /> Project Name �•oSco Forr.+er �' I 9 <br /> 1'il0 1$�, <br /> Consultant Company N l,-r - �2 a n Y Kc. ) lv 4 Carr.r , <br /> TOSCO Engineer(required) . <br /> Address 1,}y sj fa. �- S�+ <br /> City State G,e} Zip CoA LD <br /> de "11P415Y u � illi <br /> FAX # 9 2 SS/- f 8d Site #, City, State mo. II/9 y `Trac CA v <br /> Telephone g Z S"I �S l� �S�'S ❑ Level C ❑ Level B ❑ Level A <br /> of Sampler A+,�l`/1 ! QC Data Level D (standard) _ x <br /> Report To f�,� t:� Analyses Requested a <br /> Turnaround 1�10 Work Days ❑5 Work Days ❑3 Work Days ❑Drinking Water � � <br /> Time: ❑ 2 Work Days ❑ iWork Day D 2-BlHours ❑Waste Water �y� o\�`� .4k <br /> I II Ql,Other r h� ti°� <br /> CODE: ❑ M+sc ❑Detect ❑ EvalRemed Cl Demo1 ❑Closure <br /> � �� <br /> Client Date/Time, <br /> Matrix # of � Cont Sequoia's `P� +�°� �! �wQP � �° Comment <br /> Sample I D Sampled Desc Cont i Type Sample <br /> 0 <br /> ve�'AS 01 <br /> 1 ops-�✓' r16 al Ngo 3 w Cr <br /> a <br /> 4 ^ <br /> C I I (n <br /> 2 <br /> 1 f O <br /> 3 r i ay <br /> i <br /> 4 <br /> 5 I <br /> 7 <br /> 8 ! I o <br /> � ! 3 <br /> 9 <br /> " cn <br /> i0 ' <br /> Date Time <br /> Received By c� Date 3 Time lS � _ <br /> Relinquished By 3 <br /> 11 Date Time <br /> Relinquished By ��� Date j'/� /,�- Time/ I Received By <br /> Date Time <br /> Relinquished By Date <br /> l' Time Received By <br /> E, Page!of <br /> Were Samples Received in Good Conditions _ <br /> Samples on lce� ❑Yes ❑No Method of Shipment <br /> El ❑No Ik hf <br /> To be completed upon receipt of report <br /> 1) re the analyses requested on the Chain of Custody reported2 es ❑ No if no, what analyses are$stlll needed <br /> 2} the report iss i the r ed t around times ❑ No If o, what was the turnaround timer e y o <br /> ; Signature <br /> Company r ` <br /> Annroved b _ , _--- <br />