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{ r J fit 1) Jtirvr, I)IIVI • Irl 111i,,n 11111 C A 11YJ 3r • ( 1011) lid, 9000 • I AX (408) 18, i, urtt <br /> 0010 ,124,819 Striker Ave , SurlP 8 • Sacramento, CA 95834 • (916) 921-9600 FAX (1916) c121 0100 <br /> AAM <br /> J 404 N WgPt sane •Walnut Creek CA 94598 • (925) 988 9600 FAX (925) 088 1167 3 <br /> f k l 1r1 ] J 1455 McDowell Blvd North Suite D • Petaluma CA 94954 • (707) 79? 186r, FAX (Tui 1 <<r�' r� t 1,,,IJ 1551 Industrial Road • San Carlos CA 94070 • (650) 232-9600 FAX (650) ? 1? W)I� <br /> Consultant CompanyPro Pct Name <br /> ILA I _ q 37 --E. <br /> Arl�trpss `� TT 7FSG9 Enginef r (required) l <br /> t i ��i�� UP%CAL 1� c L "it ICE?rsoy1 <br /> 1 <br /> City t j i►✓� State -i( - 7,p Code -- <br /> felnplione l' T FAX fi Slte if Cit Slate <br /> �Z� 7�55 lel_ _ `fZ�-SS= -7��$ y 018 <br /> ftrpr)i 1 l+, Sarn ler <br /> P � LQ C"1 K4AA` OC. Data t PVPI D tSras,(t,rri) J Level C u l_PVP! R J I rvoI A <br /> Turnaround J 10 Work Days A5 Work Days U 3 Work Days U Drinking Water Analyses Requested �— <br /> Time 'J 2 Work Das U 1 Work Da i - <br /> Y y J 2-8 Hours U Waste Water �\ � � F° <br /> CODE U Misc U Detect U E=va1 Xt Remed J Demo! U Closure 'J Other �oa`'T °• \�a P <br /> Client Date/Time Matrix If of Cont Sequoias <br /> Sample I DSampled Desc Cont Type Sample If �Q�` 0``�� �1� 1Q�� �o�a�\° �0�v j Golnrnenls <br /> - -V x x L� -- -- <br /> 2 uP-r-l� - -- —o�-z6 --- - K ?< X - o <br /> Cr <br /> _7 MP-z- <br /> m. <br /> 110 <br /> 444� 44 <br /> 11 � <br /> n a� <br /> Relinquished BY ` - — Date ,- � Time (lReceived B <br /> ateTne�V - <br /> Relinquished <br /> By Date Time Received By Date Time <br /> r <br /> fiPhnrirusticrl ray Date � Time -� Received By � Date Time <br /> Were Sample- f iereived in (good Condition? U Yes U No Samples on tcP7 J Yes U No Method of Shipment-- _ _ Paque of <br /> To be completed upon receipt of report -" <br /> 1) Were the analyses requested on the Chairs of Custody reported? U Yes 'J No If no, what analyses are still needed? _ <br /> App0as the report Issued within the requested turnaround time? s U No If no, what was the turnaround time? <br /> d by - _ _ — _ Signature __-� _ Company ---_— *Date <br />