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�~ UU4 i�U ❑819 Striker Ave ,AW 8•Sacramento, CA 95834• (916) 921-9600 FAX (916) 921-01i <br /> ft <br /> 404 N Wiget La alnut Creek, CA 94598• (925) 988-9600 FAX (925) 988-9673 <br /> TOSCO ❑ 1455 McDowell Blvd North, Suite D• Petaluma, CA 94954• (707) 792-1865 FAX (707) 792-0342 <br /> ❑ 1551 Industnal Road•San Carlos, CA 94070• (650) 232-9600 FAX (650) 232-9612 <br /> Consultant Company Gelflcr n Project Name I Yo 3 „�r C-LC4 13 LV 0 2gS0 <br /> Address b�.y} s; cf . S��kG �- TOSCO Engineer(required) David Carp 1 LLC- <br /> City n v b 11 n State Gq Zip Code q yS`6$ !Z 3 3 3 <br /> Telephone23) SSI- SSS FAX # 9zs) Sri- 888 Site #, City, State 11 j<p s4ce k1on CA 4) <br /> U <br /> Report To nov LZC Sampler QC Data 09 Level D (Standard) ❑ Level C ❑ Level B O Level A , <br /> Y <br /> Re � <br /> Turnaround ® Analyses nested 10 Work Days ❑5 Work Days ❑3 Work Days ❑Drinking Water Y q a <br /> Time ❑ 2 Work Days ❑1 Work Day 0 2-8 Hours U Waste Water <br /> CODE: ❑Misc ©Detect 0 Eval ❑Remed U Demol t3 Closure I$Other <br /> Client Date/Time Matrix # of Cont Sequoia's �P ` �`� �° ,�� � Comments <br /> Sample I D Sampled Desc Cont Type Sample # <br /> X JWf 13F q Y <br /> 1 Mw-3- Pasj 1112-100 MZo ✓��� FA F � X o <br /> 2 TRK- tiM�s�ao tZ Jt/ao f�s0 S VoAs (7Z X X m <br /> N <br /> 3 3 <br /> p <br /> 4 } <br /> 5 <br /> 6 <br /> 7 <br /> 8 <br /> 9 ' o <br /> Cr <br /> 10 CID <br /> Relinquished By Date Time /iL30 Received By Date / ea Time <br /> t <br /> Relinquished By Date 1 i Time /33,7L7 Received By Date Time <br /> Relinquished By Date Time Received By Date Time <br /> Were Samples Received in Good Condition? lD Yes ❑No Samples on Ice9 U Yes ❑No Method of Shipment Page^of <br /> To be completed upon receipt of report <br /> 1)Were the analyses requ sted on the Ch of Custody reported? )IQ Yes ❑ No If no, what analyses are still needed? <br /> 2)Was the report a rthi re' ed turnaround time? Yes If n hat was the turnaround time? _ war r <br /> Approved by Signature Company Date <br />