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O r�{� U 885 Jarvis Drive • an Hill, CA 95037 • (408) 776-9600 • FAX (408) 782-6308 <br /> �rJ X819 Striker Ave , S •Sacramento, CA 95834 • (916) 921-9600 FAX (916) 921-010(, <br /> _ U� � U 404 N Wiget Lane • alnut Creek, CA 94598 • (925) 988-9600 FAX (925) 988-9673 <br /> U 1455 McDowell Blvd North, Suite D • Petaluma, CA 94954 • (707) 792-1865 FAX (107) 792-0342 <br /> U 1551 Industrial Road • San Carlos, CA 94070 • (650) 232-9600 FAX (650) 232-9bl2 <br /> Consultant Company — �� Protect Name �� ' ' <br /> Address _ / [ �� SV TOSCO Engineer(required) <br /> City DU 1Rt2� ✓t State Zip Code q�b S [�?�7 --- <br /> - _ IAer <br /> Telephone - FAX # 5 Site #, City, State <br /> Repot l To SamplerMiv� QC Data evel D (Standard) U Level C U Level B J Level A U <br /> Tit <br /> Turnaround U 10 Work Days >6,5 Work Days U 3 Work Days U Drinking Water Analyses Requested <br /> Time U 2 Work Days U 1Work Day U 2 8 Hours %o\ ��v, a" <br /> U Waste Water <br /> CODE U Misc U Detect U Eval XRemed ❑ Demol U Closure U Other <br /> Client Date/Time Matrix # of Cont Sequoia's <br /> Sample I D Sampled Desc Cont Type Sample # Comments <br /> _1_PN-z? 6 LA wit r 2 VDA X'I x I x <br /> 2 OP- 1 S -og�a n x `� Cr <br /> C <br /> 0) <br /> 4_ <br /> 5 Ll <br /> 60 X K <br /> 8- <br /> 9 ---- <br /> 10 � v� <br /> // 07 <br /> H(Jiriquished By Dale O Ig D J Time �?�j? Received By Date Ga�t���i Time �'� ! m <br /> s <br /> Relinquished By Date Time Received By Date Time <br /> Relinquished By Date Time Received By Date Time <br /> Were Samples Received in Good Condition? U Yes ❑ 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? U 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 _ Company flute <br /> i <br />