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j.1 00 2519 �J UOJ JWVKi , UIIVU • W101yaii hill, l.A aSUJI • (4Ub) irt)-ybUU • t-AA (4Ub) i62-b3U8 <br /> U 819 Striker Ave., Suite 8•Sacramento, CA 95834 • (916) 921-9600 FAX (916) 921-0100 <br /> Y0S <br /> �C 0 T&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: tf _ c,H PIc t�WzyS,02 Project Name: i �,o .3 <br /> Address: / TOSCO Engineer(required) <br /> 6� y S r C.uvr� su�Ec 7 r r <br /> City: ��� State: G Zip Code: <br /> Sys 61 I �' <br /> Telephone: _ s_� FAX #: z s S�_ g� Site #, City, State: 9 Z <br /> GLS <br /> Report To: o LCC Sampler:�hdr eiv �M��11 OC Data: ;&Level D (Standard) ElLevel C ❑ Level B Ll Level A <br /> Turnaround 9 10 Work Days U 5 Work Days U 3 Work Days U Drinking Water Analyses Requested <br /> Time: U 2 Work Days U 1 Work Day U 2-8 Hours o\ \ a <br /> U Waste Water �� eti� 0ti� <br /> CODE: 0 Misc. ❑Detect. 0 Eval. ❑Remed. ❑Demol. 0 Closure 0 Other <br /> Client Date/Time Matrix #of Cont. Sequoia's `P�� \P0 ��Q"� \P �o�� <br /> Sample I.D. Sampled Desc. Cont. Type Sample # Comments <br /> 1. tA W-3- Pr-,- li 28 oO �1<Z�> Jr V��'S /� x AA"TQE l t <br /> C <br /> 2. ZI,G e <br /> T <br /> 3. U <br /> 4. <br /> a <br /> 5. <br /> 6. <br /> 7. <br /> 8. <br /> 9. r <br /> 10. <br /> a: <br /> GC <br /> Relinquished By: Dater 2$ ee Time:,=/ao Received By: Date: ///XP Time: /D373'-- a <br /> Z. <br /> Relinquished By: , DatTime://`/(2 Received By: Date: Time: <br /> ( Reiinquishea tsy: I Date: I Time: I Received By: I Date: I Time: I <br /> Were Samples Received in Good Condition? ❑Yes 0 No Samples on Ice? ❑Yes 0 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? U Yes U No If no, what was the turnaround time? <br /> Approved by: Signature: Company: Date: <br />