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r uw qui na vPItO- iriv190E1 I nn, vM aOW/ '�Wo) 1!0-UODU- rAA I,4U0) IO&DJUti <br /> N? 0I 01504 K819 Striker Ave, Suite 8• Sacramento, CA 95834• (916) 921-9600 FAX (916) 921-0100 <br /> U 404 N Wiget Lane•Walnut 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 Industrial Road -San Carlos, CA 94070- (650) 232-9600 FAX (650) 232-9612 <br /> Consultant Company 7- &r)ee000 Project Name -FO SCA S <br /> Address /7�.Z � p� L�© TOSCO Engineer{required) S rpI } <br /> City If State , Zip Code ` <br /> Telephone (p 3 40 FAX # ���'c� .���� Site #,City, State 4 0 S TVC44-z>J, w <br /> Report To V 622 Sampler V��vda OC Data )�evel D (Standard) ❑ Level C ❑ Level B ❑ Level A U <br /> i[ Y <br /> Turnaround 70 Work bays ❑5 Work Days ❑3 Work Days ❑ Drinking Water Analyses Requested <br /> Time 0 2 Work Days LIa <br /> 1Work Day ❑2-8 Hours C3 Waste Water , PetiFp� p` V <br /> CODE: U Misc ❑ Detect ❑Eval ❑Remed 0 Demol ❑Closure O(Other <br /> Client Date/Time Matrix # of Cont Sequoia's `P ' Q �o° qp <br /> Sample I D II Sampled Desc Cont Type Sample # �Q�\ 0� ����' � �� w Comments <br /> 1 1BIA8 6 3 0 M 1 lot <br /> 2 WCke, 1 ° <br /> ° <br /> 3 MW C1n <br /> 4 V I o <br /> 5 <br /> 7 �ll� <br /> 8 IY1 u1 o I -- L_ <br /> 10 Or <br /> SPA, �° f vim'° <br /> CD <br /> Relinquished By Dated � ()r Time Received Datea ( Time ) <br /> w <br /> Relinquished By Date Time Received By Date Time <br /> Relinquished By Date Time Received By Date Time <br /> Were Samples Received inl�Good Condition? LI Yes U No Samples on Ice? ❑Yes ❑No Method of Shipment Page,7—o 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? 0 Yes © bio If no, what was the turnaround time? <br /> Approv Signature CompanyMow <br /> __ <br />