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N _ 000 0 r 44 U 819 Sliiker Ave , Suite 8 • Sacramento, CA 95834 • (916) 921-9600 FAX (916) 921-0100 <br /> X404 N Wiget Lane •Walnut Creek, CA 94598 • (925) 988-9600 FAX (925) 988-9673 <br /> TOSCO U 1455 McDowell Blvd North, Suite D • Petaluma, CA 94954 • (707) 792-1865 FAX (707) 792-0342 <br /> U 1551 IndUSlrtal road • San Carlos, CA 94070 • (650) 232-9600 FAX (650) 232-9612 <br /> Consultant Company G-C,T~T L C , Prot NamejecTo 5 C0ATQ (' <br /> __-- -- - _ ` _ — _ -__K- o 0-- <br /> Address Cci TOSCO Engineer (required) RAL J "FO N <br /> City V lu� State Zip Code ���i $ _ — Z '7 <br /> ----- <br /> Telephone FAX #i 4 Site #1, City, State <br /> �5�5 � - '�� 5 X51-�R - 1403 COUWT . QMu 8LV91 <br /> Report To u _ U 1r- Sampler l�' K1=Vo OC Data evel D (siandatd) U Level C U Level B U Level A U <br /> Turnaround10 Work Days U 5 Work Days U 3 Work Days U Drmkrng Water Analyses Requested <br /> 4 <br /> Time J 2 Work Days U 1 Work Day U 2 8 Hours U Waste Water 'N 4ti�, t ,, <br /> �°`� o`°y �P �tiQP �U <br /> CODE: U Misc U Detect U Bval U Remed U Demol U Closure Other �, , -�� 0 `o0 1 <br /> Client Date/Time Matrix # of Cont Sequoia's \�p�S$y Comments <br /> ��n \QP���S `o`�ao o°����� <br /> Sample 10 Sampled Desc Cant Type Sample <br /> T� Lg t 1?1/ <br /> 2 MW - _0 °J it 5 _ 02 _ <br /> Ohl <br /> Ar <br /> 5 <br /> 6 <br /> 7 — <br /> 9 b <br /> 10A. Cr <br /> W <br /> Relinquished By DateVly/0 1 Time 13;q Received By IISC ? Date Time ,sem v <br /> Relinquished B Date Time Received B Date Time <br /> q y j �0 _t�EOQ �-7T � s - 1 r 1--= c�c� <br /> Relinquished By Date Time Received By Dal Time <br /> Were Samples Received in Good Condition? ' Yes U No Samples on Ire? Xes 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 Ll No It no what analyses are still needed? <br /> 2)Waseport issued within the requested turnaround time? U Yes o If no, what was the turnaround time <br /> Approved by T _ _ _ _ _ _-- Signature Company - __- _ -- NO _ <br />