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U U1 eJJMb <br /> U 819 Striker Ave , Suite 8 • Sacramento, CA 95834 • (916) 921-9600 FAX (916) 921-0100 <br /> + 1`� U 404 N Wiget Lane •Walnut Creek, CA 94598 • (925) 988-9600 FAX (925) 988-967,3 <br /> Ur�1V � U 1455 McDowell Blvd North, Suite D • Petaluma, CA 94954 • (707) 792-1865 FAX (707) 792-0342 <br /> U 1551 Industrial Road • San Carlos, CA 94070• (650) 232-9600 FAX (650) 232-9612 <br /> C01iSUltallt Company . — Protect Namees-�- <br /> Address 67g7 16WrA, TOSCO Engineer (required) <br /> City - - D,,� +`A State � Zip Code Q�6 a 14 7 F, <br /> -�F' 1 <br /> 4 yiP_r <br /> Telephone FAX # Q25-5-5l -1888 Site #, City, State OILS-7 - b&-6f ��_------- <br /> Report Ta I !.!?L.�l n�iy �" Sampler Pal td"' to I& OC Data XLevel D (Standard) U Level C - U Level B U Level A U <br /> Turnaround , 10 Work Days X5 Work Days U 3 Work Days U Drinking Water Analyses Requested - <br /> Time J 2 Work Days U 1 Work Day U 2 8 Hours U Waste Water -.T �'o, <br /> Gal OQy <br /> 41- <br /> 101- <br /> CODE U Misc U Detect U Eval U Remed U Demol U Closure U Other h oo tion 141 � <br /> Client Date/Time Matrix If of Cont Sequoia's �QP �pp�oti �p ��0co�\`� <br /> Sample I D Sampled Desc Cont Type Sample # `Q�` ��`c� �1� �Q�` J��a~\ ��0`` Comments <br /> Z_z_ 3 11-31011-0q65- wAu, 2 0A X 1C X i _ <br /> C) C-0 <br /> 0 <br /> 3 �Jfr(- It [ 'oqS X u) <br /> - - - --- <br /> 4 _ o <br /> 5_ NP-z- zo <br /> 7 tjP-2-- � �� - - - -oqz <br /> 8 <br /> ca <br /> 10 <br /> r, <br /> �y c�c) <br /> v7 <br /> Relinquished By Date -11!161 Time JJq0 Received B V(.o _ r� f� _t_ �, Time <br /> Relinquished By Date Time Received By Date Time �I' <br /> Helincluished By Date Time Received By Date Time <br /> Were Samples Received in Good Condition? U Yes U No Samples on Ice? U Yes U No Method of Shipment--_ _ Page of <br /> To be completed upon receipt of report <br /> 1) Were the analyses requested on the Chain of Custody reported? brYes ❑ No If no, what analyses are still needed? <br /> App 4z Was the report issued within the requested turnaround time? Ye 0 11 no, what was the turnaro d times <br /> by -�- -- — Signature Company -� -_T---- _ date ��� { <br />