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i <br /> M 010173 1-1865 Jarvis Drive•pgan Bill,CA 95037•(408)776-8600-FAX(406)782-6308 <br /> 0 819 StrlkeF Ave,$vita a-Sacramento.0A95034•(91{3)921-960t?•FAX (916)921-0`100 <br /> ❑404 N Wiget Lane•Walnut Creek,CA 94596•(925)986 D6W•FAX(925)888-9673 <br /> (_„J 1455 McDowell Blvd North,Suite D•Petaluma,CA 94954+(707) 792 1885*FAX(707)792.0342 <br /> n TO.S C ❑ 1551 Industrial Road•San Carl os,CA 94070•(650)232-9600-FAX(659)232-9612 <br /> Consultant Comrpany e f-I - !� Tosco Engineer <br /> Address 1 3 t7 �VN r V -r- Il r Art $110 <br /> p f ! <br /> City " ( Stale Zip Code Site Address ( ,. -, � <br /> Telephone Fax {11a11 r 1ty,$feta `�- , <br /> Report To V Sampler ( C Qata L I D(Standard) ❑Level C ❑Levet 3 ❑Level A L Ur <br /> Turnaround 10 to Work bays r)5 Work Days ❑3 Work`Days ElDnFslang Water Analyses llayuastnd y <br /> Time ❑ 2 Work Days ❑1 Work Oay ❑2-8 Hours ❑O hob Walur Ch1 ,�$�q� a <br /> Project t ing al' oc' 4Z <br /> Client <br /> Client DatefTime Mahm #of cont Sequoia's Comments <br /> Sample I D Sa Tf led Desc Cont JTypo Sampled <br /> 1 f Y W `'O <br /> s <br /> 4 <br /> s <br /> 6 ---- <br /> 7 -- <br /> -- r <br /> 10 - - --- — cA <br /> Relinquished By Date - Trmo -j RccorVod B - Dale Tim <br /> Relinquished By Date. Time Received By Efate Timu <br /> Relln ulahed By _ Date Time Received By. Dale Time <br /> Were Samples Received In Goad CondFllon ❑Yes []No Samples on Ice? ❑Yes n No Method of Shipment__ Page Of <br /> Tobe completed upon receipt of report <br /> 1)Weie the analyses requested on the Ghaun of Custody reported? L]Yes ❑ 10 if no.what Attalyse-S are still nCodod? <br /> 2)Was the report issued wrthin iho requested turnaround time? ll Yes rk No 1t no,what was lite[uruaiound hrne? <br /> Approovad By Signature Company Date <br /> I <br />