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N? U 01551 ❑885 Jarvis Drive• Morgan Hill, CA 95037•(408)776-9600• FAX (408) 782-6308 <br /> II )NO19 Striker Ave, Suite 8•Sacramento, CA 95834• (916) 921-9600 FAX (916) 921-0100 <br /> 10 404 N Wiget Lane•Walndt Creek, CA 94598• (925) 988-9600 FAX (925) 988-9673 <br /> TOSCO <br /> ❑ 1455 McDowell Blvd North, Sujte D• Petaluma, CA 94954• (707) 792-1865 FAX (707) 792-0342 <br /> 11 ❑ 1551 Industrial Road•San Carlos, CA 94070* (650) 232-9600 FAX (650) 232-9612 <br /> Consultant Company PC)eAm Project Name S <br /> Address TOSCO Engineer(required) <br /> City State Zip Code <br /> Telephone a FAX # / � �/ Site #, City, State +� l m <br /> ReportTo 31 FSampler OC Data ElLevel D (Standard) 0 Level C ❑ Level B C1 Level A U , <br /> Turnaround10 Work Days 0 5 Work Days ❑3'Work Days ©Drinking Water Analyses Requested <br /> Time U 2 Work Days ❑ 1 Work Day d 2-8 Hours <br /> 13 Waste WaterCL <br /> CODE: G Misc 0 Detecti ❑Eval ❑Remed ©Demol ❑Closure ❑Other a, le <br /> Client Date/Time Matrix # of Cont Sequoia's eP �P 0! P�1� o� oh <br /> Sample I D Sampled Desc Cont Type Sample# �`�� �1`�'� ���&'� � m � �� Comments <br /> S 9' <br /> Wo t rya L t —1 <br /> 2 W QW <br /> Cr <br /> 3 <br /> 4 w ,y <br /> 5 1 } <br /> 6 � <br /> 7 lll <br /> 8 !l <br /> 9 <br /> 110ZY�� o <br /> Z <br /> Relinquished B m <br /> q y Date? e/ Time6-6Z Received y te"t <br /> t1C) Time J <br /> Relinquished By j Date Time Received By Date Time <br /> Relinquished By � Date Time Received By Date Time <br /> Were Samples Received in Good Condition) ❑Yes 0 No Samples on Ice? ❑Yes 0 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? 0 Yes 0 No If no, what analyses are still needed? <br /> 2)Was the report issued within the requested turnaround time? 0 Yes o If no, what was the turnaround time? <br /> Approver! t� _ry Signature _ � Company b�t� <br />