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. _ v V i LF JL A IM a iy Dinner Ave, ouire o- oacramenru, L.A y0n3,+- kV to) `.1c i-low rlln k.71a f We.I <br /> 0 404 N Wiget Lane-Walnut Creek, CA 94598 - (925) 988-9600"PAX (925) 988-9673 <br /> Tosq� o ❑ 1455 McDowell Blvd North, Suite D- Petaluma, CA 94954 - (707) 792-1865 FAX (707) 792-0342 <br /> 0 1551 Industrial Road - San Carlos, CA 94070- (650) 232-9600 FAX (650) 232-9612 <br /> Consultant Company '7` - e-ioomlloyj Protect Name �'� �/�. IA- _ a7bc- r— <br /> AddressJJ,;KA , II46iT" & 4 TOSCO Engineer(required) <br /> City State �{- Zip Code a <br /> Telephone l(p 9G0 I�3ao� FAX # f2y, Site #, City, State <br /> Report To ' Sampler 4C Data evel D (standard) 0 Level C ❑ Level B ❑ Level A <br /> Turnaround Xi0 Work Days 0 5 Work Days ❑3 Work Days ❑Drinking Water Analyses Requ a <br /> lime ❑ 2 Work Days ❑ 1 Work Day ❑2-8 Hours ❑Waste Water , <br /> CODE: U Misc ❑Detect U Eval ❑Remed U Demol ❑Closure Other � <br /> , ° <br /> Client I ate/Time Matrix # of Cont Sequoia's � `� " �p��h ��°`,q <br /> �, ` r �, C ments <br /> Sample I D Sampled Desc Cont Type Sample # <br /> 1 -7P, r,15 if Z-7-dO EP i L <br /> L <br /> C <br /> Cr <br /> 3 J71) Lb <br /> 4 W"7 ' o <br /> 5 -� <br /> 6 5! it S-0 <br /> 8 m 0-6 If 0 - <br /> 9 <br /> Z9 W-(o 50, om L,4 :-7q cd <br /> crb <br /> ,o nnw a$sb r� <br /> Relinquished By II Date ID Tlme•/7(,� Received to (� Time <br /> Relinquished By !` Date Time Received By Date Time <br /> Relinquished By i Date Time Received By Date Time <br /> Were Samples Received in Good Condition? ❑Yes ❑No Samples on Ice? ❑Yes 0 No Method of Shipment Page_ of <br /> 1[ <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? 0 Yes ❑ No If no, what was the turnaround time? <br /> Approved b I� Signature AML Company _ D <br />