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,ry U U151 V819 Striker Ave, Suite-8+Sacramento, CA 95834- (916) 921-Q600 FAX (916) 921-0100 <br /> ❑404 N Wiget LaneAMInut Creek, CA 94598 - (925) 988-9600-'PAX (925) 988-9673 <br /> frosco U 1455 McDowell BWWorth, Suite D - Petaluma, CA 94954- (707) 792-1865 FAX (70710-0342 <br /> O 1551 Industrial Road - San Carlos, CA 94070- (650) 232-9600 FAX (650) 232-9612 <br /> Consultant Company -r o gAn 0j Project Name 11, oil . I A _ 9 mjG14—T10 1 <br /> Address C,�33 t'l r t• L '*` TOSCO Engineer(required) <br /> City State Zip Code iw) <br /> Telephone 3300 FAX # qZ&. 53q Site #, City, State t���9 SR)C-K.� a <br /> Report To S Sampler - QC Data XLevel D (Standard) 0 Level C ❑ Level B © Level A v <br /> Y i <br /> Turnaround0 Work Days ❑5 Work Days U 3 Work Days 0 Drinking Water Analyses Requq§gd <br /> Time ?,2 Work Days ❑ 1 Work Day El 2-8 Hours n. <br /> ❑Waste Water , � <br /> CODE: U Misc L)Detect ❑ Eval ❑Remed ❑Demol U Closure Other }, 1 JOIN <br /> �`G5�` �ot•� ,� }� <br /> Client Date/Time Matrix #of Cont Sequoia's �p�h tiQP �e"` �� \�o``�� t� v <br /> Sample I D Sampled Desc Cont Type Sample # Comments <br /> 0 <br /> 2 r`I� 0 LQ a <br /> (D <br /> 3 N -(J@ <br /> ,U@ 3 <br /> 4 ' ,� o <br /> X 5mW- e } <br /> 6 yw- SGS <br /> 7 IO <br /> 4ET-- <br /> 8 <br /> ��'i , <br /> 9 01!(� ZO <br /> m <br /> 10 1 t tS � a <br /> a <br /> as - <br /> } ro <br /> Relinquished By Date Time Received B e t f Time <br /> Relinquished By Date Time Received By Date Time <br /> Relinquished By Date Time Received By Dale Time <br /> Were Samples Received in Good Condition? ❑Yes O No Samples on Ice? ❑Yes ❑No Method of Shipment Page_of <br /> 4 To be completed upon receipt of report <br /> 1) Were the analyses requested on the Chain of Custody reported? 0 Yes Cl 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 />