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{1 Jbt$0 JdlVIS UlIVU - MUI a. - ,m, — ---- , <br /> _ U 0,),-:38 ti { ❑ 819 Striker Suite $ Sacramento, CA 95834• (916) 921-9640 FAX () 98 921-0100 <br /> • A 404 N Wige�e •Walnut Creek, CA 94598 • (925) 988-9604 FAX (925) 988- <br /> TOSCO ❑ 1451 McDowell Blvd North, Suite <br /> D • Petaluma, CA 94954 • (707) 792-1865 FAT) 792-0342 <br /> ❑ 1551 industrial Road •San Carlos, CA 94070 • (650) 232-9600 FAX (650) 232-9612 <br /> er <br /> Consultant Company 1/5 ,[zProect Name b 131-1119 <br /> c �&V[ tnC . z <br /> G' <br /> / r -T TOSCO Engineer(required) <br /> Address � <br /> Gc...�►� ��G <br /> j I GY 15'L"I rc .J <br /> Citt State G,9 Zip Cade 945 1 Z c <br /> y + n <br /> FAX # z, S Site #, City, State f i l 9� 5 #Oe-k �O , CA °' <br /> - Telephone `�z 5 S l ' `� 5 5 (_�N$�3 U <br /> ` OC Data IN Level D (Standard) ❑ Leve! C Li Level B ❑ Level A , <br /> Report To �� Sampler A� s m <br /> �U Analyses Requested <br /> Turnaround �.10 Work Days U 5 Work Days U 3 WtHours <br /> U Drinking Water <br /> Time U 2 Work Days U 1 Work Day U 2 8 U Waste Water <br /> CODE, U Mlsc Ll Detect ❑Eval ElLl ❑Other Remed U Demol Closure <br /> Client Date/Time Matrix # of Cont Sequoia's <br /> Comments <br /> m led Desc Cont Type - Sample # �Q �� �� �Q �° 6 0 x s f3 <br /> Sample I D Sa p Y y <br /> I�—3"1 L6-OO J3 zo :i VD�s d c MW- � { <br /> _ i <br /> 2 <br /> 3 ` <br /> 4 <br /> 5 <br /> 6 <br /> 7 - <br /> 8 <br /> 9 - <br /> 110 <br /> Relinquished By Date y ;.Id M, Received By <br /> a, <br /> Date .t ctr Tjme (� <br /> Date s Time16`f V Received By Date Time <br /> Relinquished By <br /> Relinquished`By Date <br /> Time ReceGved By Date Time <br /> - page�of <br /> Were Samples Received in Good Condition? ❑Yes ❑ No Samples on Ice? ❑Yes ❑No Method of Shipment <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 /> No If no, what was the turnaround times <br /> 2)Was the report issued within the requested turnaround time? Ll Yes El Date <br /> Signature Company <br /> Aonroved by �- -- __-_ <br />