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NO 010165 ❑885,farvlS Driue Ao n hill,CA 95037 s�(40$)776.9604►FAX(40a)782,63% <br /> JP819 Striker Ave,Suite 8-Sacramento,CA 95634-{918}9214MM- PAX (916) 921.01W <br /> ldzft&T 0 ❑404 N Wlget Lana-Walnut Creek,CA 94598+ (925)988-9600 a FAX(925)988-9673 <br /> ❑1455 McDowell Blvd North,Suite 0-Petaluma,CA 94954■(707)792-1865-FAX(707)792-0342 <br /> ❑1551 Endustrral Rand-San Carlos,CA 04470-(650)232-9600-rAk(650)232-9612 <br /> Consultant Company. Tosco Engineer. kif U—k <br /> i ANG, _- - ra Al <br /> Addressd { r Site 0 <br /> City tbLwwa slate Zip Code site Addrmlow� Y CW <br /> Telephone Pax Email C City,State r1 M 1, 47 <br /> Report To r )r Sampler G> t r QC I�aka level D(Standard) U level C (]letrel R E]Level A °} <br /> Turnaround 1110 Work pays [j 5 Work Days LJ 3 Work pays n pnnking Waren Analyses Requested st <br /> Time, E] 2WorkDays ❑1 Work Day []2-B Hours 0 OtheWastee Water <br /> Project Coding <br /> Client Datt!Time Matnx #of Con] 804tioa8's <br /> Sampee i G Sampfod 00:3c Cont Type Sarnpleilt o Cvmmenls <br /> W off <br /> 2 Y Va <br /> 4 -- ---- n <br /> 5 <br /> 7 <br /> 8 - - - <br /> 9. a <br /> 10 ELI <br /> Relinquishod By. Dale= Tinlo RcCCnrad Data _ r j Timor <br /> Relinquished By. Date Time Recelved By _ Data, Time <br /> 11i31in uFshed i3y. Pate Time Received By. _ Rate Trme <br /> Were Samples Received in Goad Condition Dyes ©No Ssrttples on ice? ❑`(es ❑Ido Molhod of Shipment page of <br /> Ta he completed upon receipt of report <br /> 11 Were tha analyses requested an the Chain o1 Custody reported? )9�Yes C)No 11 no,what anaryses are still needed? <br /> 2)Was the report issued within the requested turnaround time? ❑'ties �Po If no,what was thp turnaround time? I <br /> Approved try `C �, tl�rs Signature Company. 2 {7ato <br /> , <br />