Laserfiche WebLink
rr11 ❑ 885 Jarvis Drive • n Mill, CA 95037 • (408) 776-9600 • FAX (408) 782-6308 <br /> o 0 2v 16 ❑ 819 Striker Ave . S • Sacramento, CA 95834 • (916) 921-9600 FAX (916) 921-010(0 <br /> U 404 N Wiget Lane •Walnut Creek, CA 94598 • (925) 988-9600 FAX (925) 988-9673 <br /> TOSCO 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 j/ �f J� _ �ir,�J Project Name <br /> Address ��} ['� � 7 �� TOSCO Engineer (required) -/S <br /> City`F� {� State 3�_ Zip Code <br /> FAX tf =� _ Site it City, State �C < -� �� l� _LD <br /> Telephone f�^ �� "} l �' �/ — <br /> �J Level B U Level A U <br /> Report To S ��,L Sampler �� �CSS QC Data .� Level D (standard) U Level C Y <br /> Analyses Requested <br /> Turnaround Work Days 0 5 Work Days ❑3 Work Days ❑ Drinking Water yiZ <br /> Time ❑ 2 Work Days U 1 Work Day U 2-8 Fours U Waste Water <br /> CODE: ❑ Misc ❑ Detect ❑ Eval �ed U Demol ❑Closure heroo <br /> Client Date/Time Matrix # of Cont Sequoia's `QPM }AQP �\P �QP� ��� ��°� Comments <br /> Sample 1 D Sampled Desc Cont Type Sample <br /> o <br /> rJ f' zCr <br /> 2 <br /> 3 0 <br /> 4 } <br /> 5 <br /> 6 <br /> 7 <br /> 8 ' <br /> m <br /> 9 o <br /> Cr <br /> 110 a) <br /> Relinquished By Date 5 /S -Time �� `�S Received By Date Time 3 <br /> Relinquished By Date Time Received By Date Time <br /> Relinquished By Date Time Received By Date Time <br /> Were Samples Received in Good Condition? U Yes U No Samples on Ice? ❑Yes U 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 ❑ 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 b Signature Company Date <br /> pp Y <br />