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U U U -1 ou;,Jarvis U1 we • Morgan NW, UA 95U37• (408) 7/6-96UU• FAX (408) 782-6308 <br /> ❑ 819 Striker Ave., Suite 8 • Sacramento, CA 95834• (916) 921-9600 FAX (916) 921-0100 <br /> .,�04 N.Wiget Lane•Walnut Creek, CA 94598• (925) 988-96(0 FAX (925) 988-9673 <br /> 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: — Project Name:em-cd <br /> Address: G'7 7 �' TOSCO Engineer(required) <br /> City: b � State: f� Zip Code: %4�f <br /> Telephone: ^ t��t S^� FAX #Q� �_77ff Site #, City, State: E <br /> -4 T <br /> Re t T0:��� c.i�� Sampler: QC Data: Level D (standard) ❑ Level C ❑ Level B ❑ Level A U <br /> Turnaround )(10 Work Days ❑5 Work Days ❑3 Work Days ❑Drinking Water Analyses Requested C <br /> Time: ❑ 2 Work Days ❑ 1 Work Day ❑2-8 Hours n <br /> � El Waste Water � eti�° % <br /> CODE: ❑Misc. ❑Detect. ❑ Eval. ❑Remed. ❑Demol. ❑Closure ❑Other boa o\ \ �& \�5� <br /> Client <br /> Sample I.D. Date/Time <br /> Sampled Desc. Cont. Type Sample# 1Q`�\P P �p P� o`��0`` Comments <br /> l/W-3-'PRE VOA- i -E 13 <br /> 2. .o <br /> ar <br /> 3. U) <br /> 4. o <br /> 5. } <br /> 6. <br /> 7. <br /> 18. <br /> 9. cd <br /> 10. <br /> Q <br /> (D <br /> Relinquished By Date, ime;�cW Received By: , Date://! a� Time:/yZ m <br /> Relinquished By: ��„ �, Date:J��4�v Time:/�"S'L Received By: AL <br /> Date: Time: ,S <br /> I Relinquished By: I Date: I Time: I Received By: I Date: I Time: I <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? es ❑ No If no, wh analyses are still needed? <br /> 2)Was th rt issue )vithi the req sted urnaround time es ❑ No If o, ha s the 7turagroud time?Approved by. Signatu any: �/' /C� __ Date: v <br />