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002351 V aa5 Jarvis urive • Morgan riiii, uH � vu tiouit - k,4uo� r ro- o - r-A v+uo1 ,o�-u0 11 819 Striker Ave , Suite 8 • Sacramento, CA 95834 • (916) 921-9600 FAX (916) 921-0100 ❑404 N Wiget Lane •Walnut Creek, CA 94598 - (925) 988-9640 FAX (925) 985-9673 TOSCO ❑ 1455 McDowell Blvd North, Suite D • Petaluma, CA 94954 • (707) 792-1865 FAX (707) 79r2-0342 ❑ 1551 Industrial Road • San Carlos, CA 94070• (650) 232-9600 FAX (650) 232-9612 Consultant Company 6,e V"1e r— R q n/ -S A(G Project Name Former TV,3;(-a CI A10, 6y g f Address6e� h � ®VVe'I/ � �j� TOSCO Engineer(required) Iy�,0/ City State G �' Zip Code 5 Telephone 0 71 7 _ 3a FAX # (7Q Site #, City, State 6�$1 �07 f 9G�'�IG l�rle {,n k _T Report To ` Sam ler _ QC Data A Level D (standard) ❑ Level C ❑ Level B ❑ Level A U p a U� {IO � p �eo, f, P� t� Anal ses Re uested - Turnaround 1� 10 Work Days ❑ 5 Work Days ❑3 Work Days ❑ Drinking Water Y q a. Time ❑ 2 Work Days ❑ 1 Work Day ❑2-8 Hours ❑Waste Water �� eP�'�, j\ CODE: ❑ Misc ❑ Detect ❑ Evai ❑ Remed ❑ Demol ❑Closure ❑Other Xc`o5 Client Date/Time Matrix # of Cont Sequ Comments Sample I D Sampled Desc Cont Type Sample # �Q J VW- 7 o w A- �C o -6D Cr 2 f ) 3 0 5 I ! r g i 6 - ---- I p 8 4 9 t O I : C?ti \b`' :3 10 r ) CO r f Cbl� i �Sys Relinquished By Date 0 Time Received Time Relinquished By Date Time Received By Date i Time Relinquished By Date Time Received By Date Time Were Samples Received in Good Condition? ❑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 Chain of Custody reported? ❑Yes ❑ No If no, what analyses are still needed? 2) Was report issued within the requested turnaround time? ❑Yes ❑ No If no, what was the turnaround time? Approved b Signature Company Dat \"A