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`+O i� LJ bbb Jarvis UrLve ° Mufy in Hill, UA 4.5UJ/ • t�4lJb) l:U-yuUV - r MA k-*UU J r UL u'Jvu T 0 +� 1119 Striker Ave , S 8 Sacramento, CA 95834 (916) 921-9600 FAX (916) 921-0100 ❑404 N Wiget Lane Inut Creek, CA 94598- (925) 988-9600 FAX (925) 988-9673 16sco ❑ 1455 McDowell Blv orth, Suite D- Petaluma, CA 94954 e (707) 792-1865 FAX (707)01-0342 ❑ 1551 Industrial Road- San Carlos, CA 94070- (650) 232-9600 FAX (650) 232-9612 Consultant Company Protect Name L osteo o Address 3 ) 6 2-V L7 TOSCO Engineer (required) City L^.L v State L Zip Code qgvm Telephone , FAX # _ _ Site #, City, State Report To L r� Sampler << sH ."tom OC Data R<e'vel D (Standard) ElLevel C ❑ Level B ❑ Level A U Y Tumaround W10 Work Days ❑5 Work Days ❑3 Work Days ❑Drinking Water Analyses Requested sL Time 0 2 Work Days ❑ 1 Work Day ❑2-8 Hours ❑Waste Water Q�°, CODE: 0 Misc EllDetect LlEvai ❑ Remed (ilDemoi ElClosure El Other �� o\ , IlkClient Date/Time Matrix #of Cont Sample I D Sampled Desc Cont Type Sample # �Q��eP ��`� �� 1Q� �o`� ��0�vo i'�ti Comments 7,r , Lao l3 v S Z1`x f u I. - X x 0 Cr { r at 3 /0,1.3 3, 5 , 13 t! +. f '' a N 4_t S (W2- v1 X k PP.s a 3 0 5 ft S -- I t, t7 S ,i i t so m 6 PL t, - Z. S r i' / 141/s '_ K 33 7 L ` �' lw Z..5 << t K k 8 L �'- I 0 /4, 35 t3 X ri x 9 �. A-1. g ) K X X k C, 10 Cr Relinquished By r% to LiL dp Time G Received By , tofxyo—D Time O g+ck) m Relinquished By Date Qt7 Time 060 Received By Date Time /eSd 11 ro, Relinquished By c�_ �' Date 27L,�, Time //�,s Received By Z Time Were Samples Receive n Good ondition? Yes 0 No Samples on Ice? Yes ❑No Method of ShipmentPage of 3 To be completed upon receipt of report 1)Were the analyses requested on the Chain of Custody reported? Yes ❑No If no, what analyses are still needed? 2)Was the repo issued within the requested turnaround time? Wes D No If no, what was the turn and time? Approved by a l�A�T"t�N Signature Company , ___-- _-- --- - ----- - - - - -- - --- -- - - -�-----�-- - Date