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J uoo JdIVIy UIIVt ' IVIV19dit i un, UTA .,Ou,JJ 1 tV .VI i i V- Vuv oil ' k Jul t -- �01_ V i} 002100 ❑ 819 Strikeruite 8 - Sacramento, CA 95834• (916) 921-9600 FAX (916) 92AWO ❑ 404 N Wiget e •Walnut Creek, CA 94598 • (925) 988-9600 FAX (925) 988-9 TOSCO ❑ 1455 McDowell Blvd North, Suite D - Petaluma, CA 94954 •(707) 792-1865 FAX (707) 792-0342 U 1551 Industrial Road - San Carlos, CA 94070 • (650) 232-9600 FAX (650) 232-9612 Consultant Company -n _ �J �--, Protect Name 4767 IR4i �-� e- -ftv e Address '� �� ,, � '�• TOSCO Engineer (required) City < State Zip Code 62 q SZ 'L Telephone - r" FAX Site #, City, State 6 {��t to /C r,J LD Report To <7 r d L �7i�w Sampler _;, �, OC Data Q evel D (Standard) ❑ Level C 0 Level B ❑ Level A U i .x Re Turnaround 10 WAnalyses Requested Days U 5 Work Days Ll 3 Work Days U Drinking Water Y q d Time U 2 Work Days U,,1��Work bay U 2-8 Hours U Waste Water may, `PPPI CODE: U Misc U Detect LlEval ,rt�riemed U Demol U Closure Other o�h�o° ��°\ o, ,��o° a \`a • Client Date/Time Matrix # of Coni Sequoia's �QP� �P Rp �P� �` v°°� Comments Sample I D Sampled Desc Cont Type Sample # o ' � 60! uL' O ' 4 } 5 6 7 8 9 I o a , 10 k ami Relinquished By Date `]1l �r Time 1/Qa Received By Date � l 4� Time Relinquished By Date Time 1#37 Received By Date Time 9? �ljJ Relinquished By Date Time Received By 61iC 6ater0 a Time Were Samples Received in Good Condition? ❑Yes U 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 Chain of Custody reported? O Yes ❑ No It 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 Approved by Signature Company Date