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1-1819 Striker Ave , Suite 8 e Sacramento, CA 95634- (916) 921.9600 FAX (916)921-0100 r <br /> ,404 N Wlget Lane-Walnut Creek,CA 94596-(925) 988-9600 FAX (925) 988.9673 U <br /> TOSCO O 1455 McDowell Blvd North, Suite D+Petaluma, CA 94954- (707) 792.1865 FAX(707) 792-0342 ` <br /> O 1551 Industrial Road • San Carlos, CA 94070-(650) 232-9600 FAX (650) 232.9612 <br /> Consultant Company �- J� Project Name s 0, N <br /> Address `_ , c. .�- TOSCO Engineer(required) r;�, .✓,1 <br /> v <br /> Gly State d Zip code.),,, F C <br /> r <br /> Telephone f J s 7 ,- FAX# ` • 1 - < < 7-e� Site #,City, State r ,4 a <br /> Report To j, , �`�, Sampler QG Data )Q Level D(Standard) O Level C ❑ Level 8 0 Level A v � <br /> 'r c <br /> x - <br /> Twiti round 10 Work Days O 5 Work Days O 3 Work Days O Drinking Water Analyses Requested - <br /> Tln*- ❑ 2 Work Days ❑ iWork pay O 2-8 Hours O Waste Water ! '� � a a n <br /> CODE: D Misc QDeied ❑evai C1 Remed d Demol O Closure Q 0her F <br /> z4v - <br /> `to <br /> Client Date/Time Matrix # of Cant Sequoia's Q�� �`� �'� r <br /> Sample I D Sampled Desc Cont Type Sample b° Comments <br /> j�f rQ _ <br /> niry <br /> I � r / 1 a)�r I � � � 1 1rC� X � X [p <br /> 0 <br /> 2 /t^ oZ 1 c'r <br /> 6 M.. i I - <br /> C <br /> 7 h,�,�, - 04- <br /> 9 AM0 _ le 1 Y <br /> to Mti„ '' t. !>'ti, a a <br /> � G <br /> N <br /> Relinquished By ,-�' _ � Bate 7 1-'1 r Time Received By Zix <br /> Date - Time m <br /> of <br /> Reknqushed By Date Time Received By Date Time <br /> "nqul~By Cate Time Received By Date Time <br /> ra <br /> Were Samples Received in Good Condition? O Yes ❑No Samples on Joe? CJ Yes ❑No Method or Shipment Page <br /> To be completed upon moeipt of report <br /> 1)We <br /> he analyses requested on the Chain of Custody reported U Yes ©No It no, what analyses are still needed? <br /> 2) report issued within the requested turnaround time? U Yes 010 If no, what was the turnaround time? <br /> lln-nofrxrnrl by C,r*naflorn rnmPI-Inif f1h1n <br />