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'Al (f U Ac'0-11 U 819 Striker Ave , Suite'8 • Sacramento, CA 95834 • (916) 921-9600 FAX (916) 921-0100 <br /> orosco El404 N Wiget Lan�alnut Creek, CA 94598• (925) 988=9600 FAX (925) 988-9673 <br /> U 1455 McDowell B orth, Suite D • Petaluma, CA 94954 • (707) 792-1865 FAX (70 2-0342 <br /> U 1551 Industrial Road * San Carlos, CA 94070 * (650) 232-9600 FAX (650) 232-9612 <br /> Consultant Company � �y�H Project Name S f05700/ <br /> Address 3 i Ll �� C �'µ 10 TOSCO Engineer (required) <br /> City Cr State C Zip Code 9��0 7 D <br /> Telephon_-eo 1`lw _ 3 3 v Q FAX # or(� _ 3 _ 3 Site #, city, State (�� f f f� G LD <br /> Report To JY� tri, r Sampler QC Data ld'Cevel D (Standard) © Level C D Level B © Level A <br /> Turnaround Is 0 Work Days U 5 Work Days Ir3 Work Days i U Drinking Water Analyses Requested <br /> Time U 2 Work Days U t Work Day �, �� CL <br /> U Waste Water \���� ti QPM, <br /> CODE. U Misc U Detect U Eval U Remed U Demol O Closure U Other ��`' o\ ��° � 10� <br /> � QP�°�. QPM' ��h O�°'a �<�� <br /> Client Date/Time Matrix # of Cont Sequoias AQP �� e� <br /> Sample I D Sampled Desc Cont Type Sample # � Comments <br /> L.. xL <br /> w <br /> f 1 fell - 6 3 r d X X <br /> 0 <br /> 2 <br /> 3 u] <br /> 4 <br /> 5 <br /> 6 M <br /> 7 <br /> 8 <br /> 9 <br /> d <br /> 10 Q <br /> Relinquished By ate, ''V_GU Time I/3r Received By Datef-tf-po Time &3d' m <br /> Relinquished By ��-- Date Sr-y-O(o Time A21J- Received B ate S Time <br /> Relinquished By Date Time Received By Date Time <br /> Were Samples Received in Good Condition? ( Yes U No Samples on Ice? AYes ©No Method of Shipment Page_�_of l <br /> To be completed upon receipt of report <br /> 1)Were the analyses requested on the Chain of Custody reported? Yes Q No It no, what analyses are still needed? _ <br /> 2)Was the report issued wt in the requested turnaround time? Yes q No It no, what was the turnaround time? _ <br /> Approved by =_ �_�_� Signature ��I ____ Company �_ c!1 _ � __�__ = Date t� <br />