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i ll E i ,}�.� u t o) 'idrvls ullve . Iviu ctrl I-iii, uiA y,jujt • t4UU) r rU-UUUU • I-MA k'WO) Ibe--n,)uu <br /> - l 0 2� ❑ 819 Straker Ave , S • Sacramento, CA 95834 • (916) 921-9600 FAX (916) 921-0100 <br /> Ct 404 N Wiget Lane • Inut Creek, CA 94598 • (925) 988-9600 FAX (925) 988-9673 <br /> Tosco LJ1455 McDowell Blvd North, Suite D • Petaluma, CA 94954 • (707) 792-1865 FAX (707) 792-0342 <br /> ❑ 1551 Industrial Road • San Carlos, CA 94070 • (650) 232-9600 FAX (650) 232-9612 <br />� ect Name Consultant Company Pro�-�- � Q � 1 pkizt Al C- <br /> I <br /> Address 't'� err,,, su TOSCO Engineer (required) <br /> City State C Zip CodeVOU j03J/ <br /> Telephone a,S--'7 5 s( -7T <br /> 5 S FAX # Site #, City, State �J97 S �( , <br /> Report To Sampler d per- OC Data revel D (standard) ❑ Level C ❑ Level B ❑ Level A U <br /> x <br /> L <br /> "turnaround �1 1b Work Days C15 Work Days El Work Days U Drinking Re uested g Water y q d <br /> Time U 2 Work Days ❑ 1 Work Day U 2-8 Hours ❑Waste Water <br /> CODE: 0 Misc 0 Detect 0 Eval U Remed U Demol 0 Closure U Other <br /> Client Date/Time Matrix # of Cont Se uoia's <br /> Sample I D Sampled Desc Cont Type Sample # Comments <br /> Cr <br /> U) <br /> 3 ' <br /> 0 <br /> 4 <br /> 5 <br /> 6 <br /> 7 <br /> 8 <br /> 9 cts <br /> 0 <br /> 10 Cr <br /> m <br /> Relinquished By r7� p YC f Date 3+po Time3c Received By Date 3�_�� Time 1 -7, <br /> L <br /> Relinquished By Date Time fS Received By Date Time <br /> Relinquished By Date Time Received By Date �� Time 16 '15 <br /> Were Samples Received in Good Condition? U Yes O No Samples on lce? ❑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 It no, what analyses are still needed? <br /> 2)Was the report issued within the requested turnaround time'? ❑Yes 0 No If no, what was the turnaround time? <br /> Approved by Signature Company Date <br />