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❑ 819 Striker Av v ite 8 -Sacramento, CA 95834 - (916) 921-9600 FAX (916) 921-0 <br /> i 5j 404 N Wiget L -Walnut Creek, CA 94598 - (925) 988-9600 FAX (925) 988-967 <br /> C11455 McDowell Blvd North, Suite D - Petaluma, CA 94954 - (707) 792-1865 FAX (70 792-0342 <br /> TOSCO <br /> ❑ 1551 Industrial Road - San Carlos, CA 94070- (650) 232-9600 FAX (650) 232-9612 <br /> 1 <br /> Consultant Company r i yv y Project Name /,7,0_3 u <br /> Address ' 17U� �� S� �- TOSCO,Engineer (required} l-I <br /> City n State Zip Code y _G 7 <br /> FAX # L ,Site #, City, m <br /> Telephone 9LS- -��- `3 5 Sl s%- r 8 8 Y //Z?-Z �� 4)1, C4 <br /> Report ToPuvfSampler _ OC Data �Level D (Standard) ❑ Level C ❑ Level B ❑ Level A <br /> U <br /> ' ' Re nested C <br /> Turnaround a 10 Work Days El Work Days ❑3 Work Days ©Drinking Water Analyses q d <br /> Time ❑ 2 Work Days ❑ 1 Work Day ❑2-8 Hours ❑Waste Water <br /> CODE. ❑Mise rA Detect ❑ Eval ❑ Remed ❑Demol ❑Closure ❑Other 1111 h�oav ° <br /> Client Date/Time Matrix # of Cont Sequoia's �� `Q�0 , <br /> ° �4p� �P� �� v° oComments <br /> Sample I D Sampled Desc Cont Type Sample # <br /> 1 13-- 7- gpyl(,► JA Z6 $ 1r��S Q)A - ✓ ✓ ✓ '� 0 <br /> 2 13 - Y <br /> U) <br /> 3 13 - 1 ! c' <br /> 4 13--2 0 <br /> 5 13- 3 0 } <br /> 6 <br /> 7 <br /> 8 <br /> 9 0 <br /> 0 <br /> Cr <br /> 10 0 <br /> U) <br /> Relinquished By uz Date��E�i , Time Received By ` r �, �. Date /,�'��� Time <br /> _ z <br /> Relinquished By % ,� Date r/,76 v/! Time ���] Received By _11Date Time <br /> Relinquished By DateI Time Received By Date Time <br /> Were Samples Received in Good Condition? U Yes ElNo Samples on Ice? Ll Yes <br /> Yes IU 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? ❑Yes ❑ No If no, what analyses are still needed? <br /> 2)Was the report issued within the requested turnaround time? ❑Yes 0 No 11 If no, what was the turnaround time? <br /> Approved by Signature l Company Date <br />