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4 - 1i0 Ctrii(�r A. v:i I1C 4 VCA Itl1.1 to CA 9JV34 (9161, 0,21-9VVV FAX (S1 V) J2i-V IVV <br /> ❑ 404 N.Wiget Lane •Walnut Creek, CA 94598• (925) 988-9600 FAX (925) 988-9673 <br /> TC) <br /> :11455 McDowell Blvd. North, Suite D • Petaluma, CA 94954 • (707) 792-1865 FAX (707) 792-0342 <br /> ❑ 1 lndust'ri l Road*. Sari:Carlos,.CA 940n �(650).232-9 00 FAX-(650)232-9612 <br /> Consultant Company: 41c-r— c, 73, Project Name: — <br /> Address: } <br /> d r e C�• �c� F TOSCO tnoineer (required) <br /> City: 4�U b �, h State: Zip Cade: C 'el5� �= D--TO*5 <br /> Telephone: S-_ FAX# R Site#, City. State: c <br /> evel D (Starnd�rd.) i Level qtil;Level eve <br /> B ❑ Ll A <br /> Report To: <br /> Let—, MPI, r. QC Dim: r : v <br /> Turnaround Work Days ❑5 Work Days ❑3 Work Days ❑Drinking Water Analyses Requested <br /> Time: ❑ 2 Work Days ❑ 1 Work Day ❑2-8 Hours ❑Waste Water <br /> CODE: LiMisc. etect. ElEval. ElRemed. ElDemol. El Closure ther <br /> Client DatelTime Matrix #of Cont. Sequoia's �QP�1h �o`��� �o � ' ,� � Comments <br /> Sample I.D. Sampled Desc. Cont. Type Sample # �4'Z` � � �Q'� 'g, <br /> fie`` <br /> S S- 1164 <br /> 2. <br /> O 4-A ,,., � <br /> 3. <br /> 4.. . 09;A <br /> 6 , _1 - l <br /> 7. <br /> 8. <br /> 9. <br /> 10. 3 <br /> Cr <br /> -401 <br /> m <br /> 'kllnquis � I3� Dato ZI Time: � Received By: Date Time:16()s <br /> t <br /> F�elinquished ,j1Date: Time: Received By: Date: Time: � <br /> ReIlttguishe+d 13y_ Date: Time: Received By: Date: Time: <br /> Were Samples Received in Good Condition? ❑Yes ❑No Samples on Ice? ❑Yes ❑ No Method of Shipment Page_of <br /> To be cathpleted teport; <br /> 1)Were:the an�tyse�r�quest:d cir' the Chain of Custody reported? ❑Yes ❑ No If no, what analyses are still needed? <br /> 2),Wasjhe.report issued within the4equested turnaround time? ❑Yes ❑ No If no, what was the turnaround time? <br /> ApPrrsv y; Signature: Company: <: e: <br />