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�-. ❑ 885 Jarvis Drivdworgan Hill, CA 95037 • (408) 776-9600• FAX (408) 782-6308 <br /> �� i� 1 0 0.1(Y�L X819 Striker Ave me 8 •Sacramento, CA 95834 • (916) 921-9600 FAX (916) 921- <br /> 0 <br /> ❑ 404 N Wiget Lane •Walnut Creek, CA 94598 • (925) 988-9600 FAX (925) 988-9673 <br /> ❑ 1455 McDowell Blvd North, Suite D • Petaluma, CA 94954• (707) 792-1865 FAX (707) 792-0$42 <br /> TOSCO <br /> D 1551 Industrial Road • San Carlos, CA 94070• (650) 232-9600 FAX (650) 232-9612 <br /> Consultant Company IT P Project Name 01 1 1-01, .I b — STUC.IC� <br /> Address. Al r TOSCO Engineer (required) p <br /> City nState Zip Code �� <br /> Telephone �j�_� _ FAX # 1 Site #, City, State <br /> Report To Sampler �� QC Data Level D (Standard) ❑ Level C ❑ Level B ❑ t_eyel A <br /> Turnaround 10 Work Days ❑5 Work Days ❑3 Work Days ❑Drinking Water I Analyses Requested �} <br /> Time ❑ 2 Work Days ❑ 1 Work Day 13 2-8 Hours p Waste Watery [�rs <br /> pea <br /> CODE: ❑Misc ❑Detect EIEval ❑Remed ❑Demol ❑Closure )dOiheffbtC _ 5�� o� h ° \ ` ° 1b4k <br /> ` 11f <br /> � Client Date/Time Matrix # of Cont Sequoia's QP �`P �� Qp�� °o �� C m e s ( <br /> Sample I D Sampled Desc Cont Type Sample # <br /> m M666 <br /> 2 MU) �1D Cr <br /> C <br /> 3 w-! G,� Cn <br /> 4 MW,I Ga)' Z <br /> 5 . w-lex ' <br /> •Z DCA <br /> s MU),101 � / 0 k -� I <br /> C y <br /> Relinquished By DateTime 0%7 Received By Date Time <br /> Relinquished By Date Time Received Byzlol Date Time 3 <br /> I;VtwRelinquished By Dale Time Received B Date Time CSG <br /> r <br /> Were Samples Received In Good Condition? ❑Yes ©No Samples on Ice? ©Yes ❑No L ethad of hipment 'page_of <br /> To be completed upon receipt of report <br /> 1)Were the analyses requested on the Chain of Custody reported? ❑Yes O No If no, what analyses are still needed? T <br /> 2) Was the report issued within the requested turnaround time? ❑Yes ❑No It no, what was the turnaround time? } <br /> Approved by Signature Company <br />