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UItU12 1V utsiu binKerAve, bunets-1.bacramen[o, �Hyawl+• kaion aci-uouu rt%A kV6Q) Uc u1uu <br /> 0 404 N.Wig ne-Walnut Creek, CA 94598- (925) 988-9600 FAX (925) 988- <br /> 01455 McDlvd North, Suite D'-Petaluma, CA 94954- (707) 792-186 792-0342 <br /> Tosco 01551 Industrial Road-San Carlos, CA 94070- (650) 232-9600 F <br /> Consultant Company �L Ti _ Profect�6me•j� r L <br /> Address, (� r-}'7 Sl�� J TOSCO Engineer(required) <br /> C#ty v�� State Zip .( 616:35 J <br /> f� w <br /> e4ephpne. S r r� FAX State: m <br /> V u _ <br /> 7 P p , ,�� QC Dat' C Level D(standard} D Level C ❑ Level B D Level A v <br /> Report To Sam ler M -cc7S}� x <br /> ' Anal ses Re uested <br />� 7Lrnaround �1#Work Days ❑5 Work Days ❑3 Work Days ❑Dunking Water F Y 4 a <br /> Tfnts: O 2 Work Days 0 i Work Day 0 2-8 Hours 0 Waste Water <br /> CODE: ❑Misc ❑Detect ❑Eval ❑Remed 0 Demol ❑Closure 0 Other { <br /> Client DateMme Matrix #of Cont. Sequoia's Comments <br /> Sample I D Sampled Desc Cont Type Sample# ,o`'� <br /> ,, ,� ,'� •G u u L� 3 V►o A, g C <br /> 1 <br /> } <br /> z. Cy <br /> 3. it <br /> 4. y { <br /> t3. <br /> 9. �` E G <br /> 10. '' 9 <br /> n i a U <br /> Relinquished By/', Lk <br /> Received Lay- Date ..r -CIO Time <br /> Relinquished By Date: - Time: Received By. ' Date Time 3 <br /> 1' <br /> Reiinqutshed By Date: Time: Reoelved By: -a, Date ��� w Time j� ►G <br /> If <br /> Were Samples Received In Good Condition? 0 Yes 0 No ,Samples on Ice? Oyes �©No Method of Shipment Page_of <br /> To be completed upon receipt of report. <br /> 1 y Were the analyses requested on the Chain of Custody reported? 0 Yes 0 No If no,�what analyses are still needed? <br /> 2)Was the report issued within the requested turnaround time? 0 Yes 0 No ,; If no, what was the turnaround time? <br /> Approved by Signature, 3 Company: <br /> Date <br />