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1 !' (1(��/�I, I' S.d uu� V41Y1'] VIIV4 muly41111111, V! VafwVf %TWwj IIV �IVVV I ,%,% k-wj •- W- <br /> U <br /> `l�iJ U U U 4 ❑ 819 Striker Suite 8•Sacra11 mento, CA 95834• (916) 921-9600 FAX (916) 9 100 <br /> ❑404 N Wig e•Walnut Creek, CA 94598• (925) 988-9600 FAX (925) 988- <br /> x _ Tosco El 1455 McDowell Blvd North, Suite D� Petaluma, CA 94954• (707) 792-1865 FAX 707) 792-0342 <br /> ❑ 1551 Industrial Road•San Carlos, CA 94070• (650) 232-9600 FAX (650) 232-9612 <br /> Consultant Company Q �� Protect Namei9. 375 IR69V <br /> Address �u� TOSCOiIEngineer (required) rag /(��L� <br /> City b I F^�, State Zip Code 17 i AW 9 -7 <br /> Telephone -r 5 FAX #f �g Site#, City, State f �� � eA <br /> Report To r ('N- Sarn#* w rn o/t`bs QC Data 4evel D (standard) ❑ Level C ❑ Level B ❑ Level A U <br /> Y <br /> Turnaround 10 Work Days ❑5 Work Days ❑3 Work Days ❑Drinking Water i Analyses Requested a. <br /> Time: ❑ 2 Work Days ❑ 1 Work Day ❑2-8 Hours ❑Waste Water ' <br /> CODE: LiMisc ❑Detect - ❑ Eval' ElRemed L3Demol ❑Closure KOther <br /> Client Date/Time Matrix #of Cont Sequoia's P ��Vie" tiV� �P �m ��A° Comments <br /> Sample I D Sampled Desc Co c.Type Sample#ho /0, V o 0, 499 XL2( <br /> 0 <br /> 2 � 2 2 (3VOL o1 i <br /> f i <br /> 1 <br /> 3 <br /> 4 <br /> 5 <br /> 6 I <br /> 7 <br /> 8 <br /> g i ;f <br /> 10 i Cr <br /> i <br /> Relinquished By ate Time*/*/ Received By Date �� Time <br /> Relinquished By date Time -Received By Date Time <br /> Relinquished By Date Time Received By Date J Time /�•aZ�` <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 IF <br /> 1)Were the analyses requested on the Chain of Custody_reported? ❑Yes ❑ NoIf no, what analyses are still needed? <br /> 2)Was the report issued within the requested turnaround time? El Yes ❑ No �'If no's what was the turnaround time? <br /> Approved by Signature Company Date <br />