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n U 885 Jarvis Drive • Mor an Hdl, CA 95037+ (408) 776-9600 • FAX (408) 782-6308 <br /> �_ U 0119 f 4819 Striker Ave , Su Sacramento, CA 95834 4, (916) 921-9600 FAX (916) 921-0100 • <br /> U 404 N Wiget Lane, nut Creek, CA 94598 + (925) 988-9600 FAX (925) 988-9673 <br /> jJiV� L U 1455 McDowell Blvd North, Suite D e 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 /> Consultant Company / nL Project Name G- <br /> Address 67)7 51`67-x c 5 o i + �J TOSCO Engineer (required) <br /> Icily Air' State CA Zip Code gyswg Z137 , N, e- <br /> Telephone 7Z5-5S/-7555J« ,T! �Z�"S�S! <br /> FAX # Site #, City, State <br /> - 8$ T) <br /> Report To l� QM�+ Sampler QC Data XKevel D (standard) U Level C U Level B U Level A v <br /> �c <br /> Turnaround U 10 Work Days 1(5 Work flays U 3 Work Days U Drinking Water Analyses Requested <br /> a <br /> Time U 2 Work pays U 1 Work Day U 2-8 Hours U Waste Water aS, ��, Q��ry�, QaOR�, <br /> Q., o � �. <br /> CODE: U Misc U Detect U 6val gRemed U Demol 0 Closure U Other h�� \ ��� ��`& boo <br /> Client Date/Time Matrix # of Cont Sequoia's �QP� �\� ��" �Qp� �\°�� Comments <br /> Sample I D Sampled Desc Cant Type Sample # <br /> 0Z � 00 - 1015 U- 2 VDA 0 <br /> 0 <br /> 3 <br /> 4 3 <br /> 0 <br /> Y, x L } <br /> 6 -z 6o <br /> 8 <br /> 9M <br /> ----- o <br /> 10 <br /> I <br /> Relinquished [3y r Date t -1 Time <br /> n� s - <br /> Relinquished By Date Time Received By Date Time 3: <br /> Relinquished 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 — Pdge of <br /> To be completed upon receipt of report <br /> 1) Were the analyses requested on the Chain of Custody reported? LI Yes U No If no, what analyses are still needed? <br /> 2) Was the report issued within the requested turnaround time? U Yes U No If no, what was the turnaround time? <br /> Approved by —-- _Signature--_ <br />