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❑885 Jarvis Drive- rgan Hill, CA 95037 •(408) 776-9600• FAX (408) 782-6308 <br /> 001297 ❑819 Striker Ave , W 8 • Sacramento, CA 95834 • (916) 921-9600 FAX (916) 921-010. <br /> iyk C3404 N Wiget Lane •Walnut Creek, CA 94598• (925) 988-9600 FAX (925) 988-9673 <br /> U�L^-r-x ❑ 1455 McDowell Blvd North, Suite D• Petaluma, CA 94954• (707) 792-1865 FAX (707) 792-0342 <br /> ❑ 1551 Industrial Road•San Carlos, CA 94070• (650) 232-9600 FAX (650) 232-9612 <br /> Consultant Company Yt1W tAL Project Name <br /> :Address � TOSCO Engineer (required) �L <br /> �� S� x{37 F. �l.r,,�,r�-� _ <br /> City �j+� State � Zip Code �S� <br /> QQ Site #, City, State O I V ��, <br /> Telephone ] •ss+♦- '7555- X ja FAX # � .ss `7BSV U <br /> Sampler OC Data Level D (standard) O Level C 7 Level B ❑ Level A Y <br /> �FRIep�tTb LQ Kaµ K <br /> Analyses Requested a <br /> Turnaround ❑ 10 Work Days Work Days ❑3 Work Days ❑ Drinking Water ` , <br /> Time ❑ 2 Work Days ❑ 1 Work Day ❑2-8 Hours p Waste Water <br /> CODE: ❑Misc ❑Detect ❑ Eval ❑ Remed ❑ Demol ❑Closure ❑Other 4� <br /> C <br /> lient SamDateTled Desrc Cont Type Sample #ix # of Cont Sequoia's `P \ �`� �Q��Q Jo�a``� �ti��'v Gvmments <br /> Sample P <br /> �[� o�* o� �� z V* o 12-� K x x 0950 X <br /> 4 E S ACT } <br /> 5 -z-�a N T ACT❑ <br /> I)OL, R PE TU E ° <br /> 7 r� t°Z° <br /> 8 <br /> O <br /> 9 ' <br /> Cr <br /> 10 <br /> Relinquished By <br /> Date Time 13Z�� Received By 44 Dat /0{ Time f <br /> Date Time Received By Date Time <br /> Relinquished By <br /> Relinquished By <br /> Date Time Received By Date Time <br /> Were Samples Received in Good Condition? 0 Yes El No Samples on Ice? ❑Yes ❑No Method of Shipment Page of <br /> _ <br /> I <br /> To be completed upon receipt of report _ <br /> 1)Were the analyses requested on the <br /> ltourna bund time'�ed9�Yess Q❑ No No If nof, whathat was the tuenarauntdlt time? ----- <br /> 2) Was the report issued wtthifi theDate �._.— <br /> Approved by Signature Company <br />