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l`+� 340 -1 LJU J Jai v45 viiVi- - IdiUiyuii I Jill, '­M :JJUJI • k-4UUj ! I U JUUU • I Nn k-IUU) 10- UJUU <br /> l U 819 Striker Ave , Su ie 8 • Sacramento, CA 95834 • (916) 921-9600 FAX (916) 921-010 <br /> osco U 404 N Wiget Lan alnut Creek, CA 94598 • (925) 988-9600 FAX (925) 988-9673 <br /> U 1455 McDowell BI Orth, Suite D • Petaluma, CA 94954 • (707) 792-1865 FAX (7071792-0342 <br /> U 1551 Industrial Road • San Carlos, CA 94074 • (650) 232-9600 FAX (650) 232-9612 <br /> Consultant Company G �_ r _ Project Name z <br /> Address � 1 TOSCO Engineer (required) r <br /> City r o r� Ate Zip Code <br /> _ Q✓u <br /> Telephone U 3 f9 Q FAX # site #, city, State <br /> Report To M Sampler M. QC Data WkLevel D (standard) U Level C U Level B U Level A U <br /> x <br /> Turnaround Wj M Work Days U 5 Work Days U 3 Work Days U Drinking Water Analyses Requested ILc <br /> Time U 2 Work Days U 1 Work Day U 2 8 Hours U Waste Water �� ati�, 0/0' <br /> `nrhas\ D,g'�' �QQ F �v <br /> CODE' U Misc U Detect U Eval U Remed dl eol U Closure U Other �� boa 5L a�A�y }6 <br /> Client Date/Time Matrix # of Cont Sequoia's �P ``1°°� <br /> Sample, I D Sampled Desc Cont Type Sample # �Q�\ ��`� 11Q�� �o\a ���v c�'� �� Comments <br /> 2ItXVN <br /> 1 eL.IC7 "`17 ' s� s A t r 1 kC5U -C4 —X o <br /> 2Z. vi f10S <br /> a <br /> �j � ) rn <br /> i -- <br /> 4 0 <br /> 5 <br /> 6 <br /> 7 <br /> 8 <br /> 9 cc <br /> 10 <br /> a� <br /> to <br /> Relinquished By a= L Time /��s Received BY, < d Date _��� Time15 <br /> Relinquished By - Date S y-L� Time /dimes <br /> _ Received D Time <br /> Hellnqul-tied By, Date Time Received By Date Time <br /> Were Sample, Received in Good Condition? Yes U No Samples on Ice? Yes U No Method of Shipment_ re,t&L Page— of <br /> To be completed upon receipt of report <br /> 1) Were the analyses requested on the Chain of Custody reported? Yes IJ No It no, what analyses are still needed? _ <br /> 2) Was the ie art issued within the requested turnaround time? Yes if o, what was the turns/ro d time? _ <br /> Approved by r�� �""! - Signature <br /> ,*s1 <br /> __ _ _ Company __ `� _ Date <br /> I <br />