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w " 000b80 U 819 Striker Aveto 8 • Sacramento, CA 95834 • (916) 921-9600 FAX (916) 921-49 ! ❑ 404 N Wiget L Walnut Creek, CA 94598 • (925) 988-9600 FAX (925) 988-9673 TOSCO © 1455 McDowell Blvd North, Suite D • Petaiuma, CA 94954 • (707) 792-1865 FAX (707) 792-0342 ❑ 1551 Industrial Road • San Carlos, CA 94070• (650) 232-9600 FAX (650) 232-9612 Consultant Company �, L�2Al ✓ - Protect Name d 5 C Address 7 , /1 j ie- TOSCO Engineer (required) q City j I h L , ,J State `- Zip Code Telephone — PAX �ZS) /-] Site #, City, State �I D � d C-�l [��"�` l - 1 II Level C ❑ Leve1 B ❑ Level A v Report To o LS i.�J Sampler DLS2 OC Data Level D (Standard) ❑ Lee , Re Turnaround 10 Work Days ❑5 Work Days ❑3 Work Days El Drinking Water [Analyses Requested � Time ❑ 2 Work Days ❑ 1 Work Day ❑2-8 Hours p Waste Water �\ �I& a Q CODE: ❑Misc LI -Detect ❑ Eval Remed Q Demol ❑Closure ❑Other ��o o, ��o iClient �1h ate/Time Matrix # of Cont Sequoia'sP�p`L p�tio� �O,y O`D,a c�\��` Sample I D DSampled Desc Cont Type Sample # P �� \� �P �e� Vo Comments I 1 64(-" -r f0-) i 2 QI/ _ ] !_e>LLtS 1jvc- VIJ o I r��L� I d / _ Cr 2 cn 3 17 3 0 4 } 5 6 7 8 9Cr 0 10 Relinquished By Date Time /5'� Received By tom,(( Date �L / Time S= CD Relinquished By Date Time p Received By Date Time A�q,,Relinquished By Date Time Received By �/�`r- --�rtc Date /a �� Time �G fib Were Samples Received in Good Condition's ❑Yes ❑No Samples on Ice? ❑Yes ❑No Method of Shipment Page _of To be completed upon receipt of report 1)Were the analyses requested on the Chairs of Custody reported? ❑Yes ❑ No If no, what analyses are still needed? 2)Was the report issued within the requested turnaround time? ©Yes ❑ No If no, what was the turnaround time? Com an Date Approved by Signature p Y i