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i� U U1JUD ❑819Striker Ave , Suite-8•Sacramento, CA 95834 •(916-921-9 FAX {916} 921-0100 <br /> Tosco ❑404 N Wiget La�Watnut Creek, CA 94598•(925) 988-9600 FAX (925) 988-9673 <br /> C31455 McDowell North, Suite D • Petaluma, CA 94954• (707) 792-1865 FAX (70 92-0342 <br /> © 1551 Industnal Road•San Carlos, CA 94070• (650) 232-9600 FAX (650) 232-9612 <br /> Consultant Company <br /> Address T Protect Name <br /> -r B TOSCO Engineer(required) 5 <br /> City \� T'D StaterA_ Zip Code 9 3 <br /> Telephone `IzS- 3300 FAX# 9 <br /> 1 <br /> t097 <br /> 3�T Site #, City, Stated f <br /> K . WAuv _m <br /> Report To 0 Sampler OC Data © Level D (Standard) ❑ Level C ❑ Level B L] Level A v <br /> Turnaround -�<10 Work Days ❑5 Work Days ❑3 Work Das ❑Drinking Water <br /> Days <br /> 9 Analyses Requested <br /> Time U 2 Work Days ❑ t Work Day O 2-8 Hours c� <br /> ❑Waste Wafter ` 0, <br /> CODE: ❑Misc ©Detect ❑Eval U Remed LlDemol LJ Closure 'Other ° <br /> ClientDate/Time Matnx # of Cont Sequoia's 14 AQP �.01 \P40 \°o*q <br /> Sample I D Sampled Desc Cont Type Sample # �Q`Z` ��� ��� �Q� °�m�` ��0`� Comments <br /> Y1U�1, Cir 0 <br /> 1 ' $3DI o I L t <br /> 2Cr <br /> 6 LJ 15- <br /> 7 MZ, <br /> 8 <br /> 9-M <br /> 10 <br /> 0 <br /> 3 <br /> Relinquished By <br /> ate }�� Timevy Time <br /> Received B Q t)5 <br /> it ©( <br /> Relinquished By Date Time Received By DateTime C <br /> Relinquished By Date Time Received By Date Time <br /> Were Samples Received in Good Condition? ❑Yes ❑No <br /> Samples on Ice? El Yes ❑Na 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? y eded <br /> 4 ©Yes D No If no, what was the turnaround time? <br /> Approved by Signature Company <br /> Date <br />