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�� r ,� u buy Jai vis Urwe- IVluigal 1 11111, UA 9L)UJ1 - k4UO) /U-`.000U * I ran t4Ub) ibe-U,)Uu <br /> - 002522ti U 819 Striker Ave., Suite 8- Sacramento, CA 95834- (916) 921-9600 FAX (916) 921-0100 <br /> ®S0® U 404 N.Wiget Lane-Walnut Creek, CA 94598- (925) 988-9600 FAX (925) 988-9673 <br /> U 1455 McDowell Blvd. North, Suite D - Petaluma, CA 94954- (707) 792-1865 FAX (707) 792-0342 <br /> U 1551 Industrial Road- San Carlos, CA 94070- (650) 232-9600 FAX (650) 232-9612 <br /> Consultant Company: G y� ;THC Iypz -,v Project Name: p vv�� CL�✓/.3 L(,�/,� <br /> Address: �,y SiLr+-ice TOSCO Engineer(required) <br /> rh/ <br /> City: OU b'f n State: Zip Codegy$V,9 <br /> Telephone: �2�- s sl_ FAX #: (c7 t.�-)$-A-/- Site #, City, State: <br /> Report To: �� Sampler: S, , QC Data: bevel D (Standard) ❑ Level C ❑ Level B U Level A <br /> Turnaround A10 Work Days ❑5 Work Days ❑3 Work Days ❑Drinking Water Analyses Requested <br /> Time: 0 2 Work Days U 1 Work Day ❑2-8 Hours n` <br /> ❑Waste Water 0ti 0ti <br /> CODE: ❑Misc. Detect. U Eval. U Remed. ❑Demol. U Closure ❑Other X41 o\ oa°so <br /> ooh �� �tio� ���� <br /> Client Date/Time Matrix # of Cont. Sequoia's \P0 �Q " `P0 Comments <br /> Sample I.D. Sampled Desc. Cont. Type Sample# �Q'�' ��c�`�� ��0 �Q`Z' �o�' ��� <br /> 1. n^w - oaf ttA13100 ih© � Vv4� 1 >( /' � y" 'r t3,ff MX s <br /> 2. s <br /> As Z8 o- (moo S Vd43 X 4Ld <br /> 4. <br /> 5. <br /> 6. , <br /> 7. <br /> r 8. <br /> t <br /> 9. <br /> 10. <br /> as <br /> v; <br /> Relinquished By: Date:i� ,v Time: RX) Received By: r � • DateTime: /,2.53� <br /> r <br /> Relinquished By: �,� Date: illV Time: 1140 Received By: Date: l q Time: 3 <br /> IRelinquished By: I Date: I Time: I Received By: nate: T ime: <br /> Were Samples Received in Good Condition? ❑Yes O No Samples on Ice? ❑Yes O 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 U 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 />