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N? 002369 ❑ 885 Jarvis Drive- Morgan Hill, CA 95037 - (408) 776-9600 - FAX (408) 782-6308 <br /> [ 819 Striker Ave , Suite 8 • Sacramento, CA 95834- (916) 921-9600 FAX (916) 921-0100 <br /> L1 404 N Wiget Lane -Walnut Creek, CA 94598 - (925) 988-9600 FAX (925) 988-9673 <br /> Tosco <br /> ❑ 1455 McDowell Blvd North, Suite D - Petaluma, CA 94954 - (707) 792-1865 FAX (707) 792-0342 <br /> ❑ 1551 Industrial Road - San Carlos, CA 94070 - (650) 232-9600 FAX (650) 232-9612 <br /> Consultant Company 6 -er— K N� Project Name rm r' Seg �5 6 q gl <br /> Address 3 G6. wrie (f TOSCO Engineer(required) ,fid <br /> City 94ech® Of 0 State Zip Code L156 Q <br /> Telephone (q[6) d —I3 ev FAX # /97 site #, City, state 6q 5fvckYv ly, 4t <br /> ReportTo � Sampler (�P G �' QC Data C3 Level D (Standard) C3 Level C El Level B ❑ Level A U <br /> Turnaround CA0 Work Days ❑5 Work Days ❑ Work Days ❑Drinking Water Analyses Requested a <br /> Time ❑ 2 Work Days ❑ i Work Day ❑2-8 Hours ❑Waste Water V�°, <br /> At QP QP <br /> CODE: ❑Misc ❑ Detect ❑ Eval ❑ Remed ❑ Demol ❑Closure ❑Other boa <br /> Client Date/Time Matrix #of Cont Sequoia's P� ��eP ti�eP `� ' �\o �V°�` Comme <br /> 6ants <br /> Sample i D Sampled Desc Cont Type Sample # �Q� ��`� ��� �Q� 1\ <br /> 2 Mid— {b G 0 GZ�Q�V- oQ <br /> m <br /> 3 <br /> 4 <br /> 5 <br /> i <br /> 6 <br /> 7 <br /> 8 <br /> 9 <br /> o <br /> 10 <br /> " a7 <br /> Relinquished By Date Timef ,337 Received to Time ��—� m <br /> F- <br /> Relinquished By Date Time Received By Date Time 3 <br /> Relinquished By Date Time Received By Date Time <br /> Were Samples Received in Good Condition? ❑Yes ❑ No Samples on Ice? ❑Yes ❑ 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? ❑Yes ❑ No If no, what analyses are still needed? <br /> 2)Was report issued within the requested turnaround time? ❑Yes o If no, what was the turnaround time? <br /> Approved bJ Signature Company Dat <br /> n <br />