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0 0 23'74 V85 Jarvis Drive • Morgan Hill, CA 95037 • (408) 776-9600 • FAX (408) 782-6308 <br /> N'-1 819 Striker Ave ite 8 • Sacramento, CA 95834 • (916) 921-9600 FAX (916) 921-0 <br /> ❑ 404 N Wiget L •Walnut Creek, CA 94598 • (925) 988-9600 FAX (925) 988-967 <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 (�e-*te r— K q N f :"mL Project Name Frn e' "rOS Co 6 f l <br /> Address 3 Ire G p Id Ca yq p Vr f, 17 a TOSCO Engineer (required) Ed Aa fs fO 1� <br /> City �yNr6 lerdov State C�` Zip Code g56710 <br /> Telephone N10631- 13061 FAX # 11t61431-1,T1 7 Site #, City, state 6 $� '707 iP�t,"fig �v� 5��kf�p/ C�- LD <br /> Report To V bt V-e. VeS31ey- Sampler � OC Data Level D (Standard) ❑ Level C ❑ Level B ❑ Level A v <br /> Turnaround 10 Work Days ❑5 Work Days ❑3 Work Rays ❑ Drinking Water Analyses Requested <br /> a <br /> Time ❑ 2 Work Days ❑ 1 Work Day ❑2-8 Hours ❑Waste Water �� �ti'01 <br /> CODE- ❑ Misc ❑ Detect ❑ Eval ❑ Remed ❑ Demol ❑Closure ❑Other �h�oa <br /> Client Date/Time Matrix # of Cont Sequoia's �Pqyl +LPA `P�� ��� `` Comments <br /> Sample I D Sampled Desc Cont Type Sample <br /> IVV- 7 a Wafer 3 V 0 x x x � <br /> 2 W 16 aVF �e A X o <br /> �-oCr <br /> U) <br /> 3 { <br /> 4 � <br /> 0 <br /> r <br /> 5 <br /> 6 <br /> 7 <br /> 8 <br /> 9 <br /> 0 <br /> 10 J <br /> a� <br /> U) <br /> Relinquished By Date,5//6 Time f Received y Time <br /> s <br /> Relinquished By Date Time Received By Date Time <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 the report issued within the requested turnaround time? ❑Yes ❑ No If no, what was the turnaround time? <br /> Approved by Signature Company Date <br />