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(� """5 r,�� J 000 Jarvis unve • muryan riiu, VH aJuo/ • (µud) u-yuuu • r Hn kwuC3) Ibe--V,)uu <br /> 2 U, <br /> U U U 819 Striker Ave., Suite 8• Sacramento, CA 95834• (916) 921-9600 FAX (916) 921-0100 <br /> S <br /> �� C1 404 N.Wiget Lane•Walnut Creek, CA 94598• (925) 988-9600 FAX (925) 988-9673 <br /> ❑ 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 1�`��— �N� �ypt�S.0 t Project Name: lye ` vN t - <br /> Address: TOSCO Engineer(required) <br /> City: State: 1 Zip Code: t'J <br /> Telephone: '�� �S\_'1�`r� FAX #:��`=1�� Site #, City, State: ��m <br /> Report To: (r �C� Fampler: NG- -w �`Cr��Z\� QC Data: Level D (Standard) ❑ Level C ❑ Level B ❑ Level A -�e <br /> U <br /> Turnaround 10 Work Days ❑5 Work Days ❑3 Work Days ❑Drinking Water Analyses Requested <br /> Time: ❑ 2 Work Days ❑ 1 Work Day ❑2-8 Hours ❑Waste Water <br /> CODE: ❑Misc. Wetect. ❑ Eval. U Remed. ❑Demol. ❑Closure Other boa o\ JIS• <br /> lient <br /> ooh Doti �° o`h �a <br /> Sample I.D. Sampled DesComments <br /> c . Cont. Type Sample # Commix #of Cont. Sequoia'sents <br /> 1 t ►`� 4 0 <br /> 2 Cr <br /> a� <br /> 3 <br /> 4. }0 <br /> 5. <br /> 6. <br /> 7. <br /> 8. <br /> 9• o <br /> 10. ami <br /> W <br /> Relinquished By: Date:i f i:lao Time: }ip Received By: Date: ( Ankn Time: <br /> r <br /> Relinquished By: Date: Time: Received By: Date: Time: <br /> I Relinquished By: I Date: I I ime: tieceiveu By. 114th. Tirnp- <br /> I.- I 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? ❑Yes ❑ No If no, what analyses are still needed? <br /> 2)Was the report issued within the requested turnaround time? ❑Yes ❑ No If no, what was the turnaround time? <br /> Approved by: Signature: Company: Date: <br />