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N " U 0 231 Jal vlb Ui Nu • IvlUiydl i I till, LA UbUd/ • (IlUu j I iU-yUUU • I-AA (-IWd) /02-0JUd <br /> � 19 Striker Ave , to 8 • Sacramento, CA 95834 • (916) 921-9600 FAX (916) 921 01 <br /> U 444 N Wiget LarWalnut Creek, CA 94598 • (925) 988-9600 FAX (925) 9884673 <br /> OscoLJ 1455 McDowell 137M North, Suite D • Petaluma, CA 94954 • (707) 792-1865 FAX (707 92-0342 <br /> U 1551 Industrial Road • San Carlos, CA 94070• (650) 232-9600 FAX (650) 232-9612 <br /> Consultant Company _ Protect Name__-- c,,&, C <br /> Address <br /> L �' r TOSCO Engineer (required) <br /> Cityv�o v Stat C� Zip Code 916 ?0 ' <br /> Telephone ��� - G 3 I - 1 3 d 4 �- FAX # 9i� _�3r- I) site #, Clty, state (� J 1 SfC14 _Y <br /> Report To f.( IA4 �r Sampler Iq A. e. fie, QC Data 0-1:16vel D (Standard) U Level C U Level B ❑ Level A U <br /> Turnaround J"10 Work Days ❑5 Work Days U 3 Work Days U Drinking Water Analyses Requested ° <br /> Time U 2 Work Days 0 1 Work Day U 2 8 Hours U Waste Watere�� ��`O d: <br /> 1 ��°� <br /> CODE: U Misc U Detect U Eval U Remed U Demol U Closure U Othero�h�� O 1 <br /> Client Date/Time Matrix # of Cont Sequoia's Comments <br /> Sample I D Sampled Desc Coni Type Sample # �Q� ��` ��� �Q� Jo�� ��� , <br /> 1 t 7 `f z d o ag I !N 1 j l` "Vy-2 Te2 <br /> Z� r it t3y� 5 X X <br /> `a <br /> 3 3 �7 -ir 1335 S x x x uD <br /> P` Z� t tl I3ss x x ,� 3 <br /> x ° <br /> 5Tp_S — J `t i33 0 S -CfD X X, } <br /> -6--Z1 r '' I t4 Z's --C n X Y, 2-ol 1f(eF-3-3"/33 <br /> 7 <br /> 8 <br /> 9— co <br /> 10 o <br /> ev <br /> Relinquished By fit, .._ ate r�'`1d c} Time �({ f U Received By Date4 Time ' , <br /> Relinquistie;d By Date Tune Received By Date Time: >> <br /> Relinquished By Date I Time 1 Received By Date Time <br /> Were Samples liecelved in Good Condition? U Yes U No Samples on Ice? U Yes U No Method of Shipment---- _ Pagi _ of <br /> To be completed upon receipt of report T <br /> 1) Were the analyses requested on the Chain of Custody reported? Yes U No If no, what analyses are still needed? <br /> 2) Was the ieport issued wit the requested turnaround time? s No It no, what was the turns annnd time? _ _ <br /> Approved try — T'w Sictn�itiue Company r ►`~ ilolc�r/G <br />