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*N? 002378 C3885 Jarvis Drive • Morgan Will, CA 95037 • (408) 776-9600 • FAX (408) 782-6308 <br /> ;1819 Striker Ave ate 8• Sacramento, CA 95834 • (916) 921-9600 FAX (916) 921-0A <br /> ©404 N Wiget La Walnut Creek, CA 94598 • (925) 988-9600 FAX (925) 988-9673 <br /> ❑ 1455 McDowell Blvd North, Suite D • Petaluma, CA 94954 • (707) 792-1865 FAX (707) 792-0342 <br /> TOSCO <br /> © 1551 industrial Road • San Carlos, CA 94070 s (650) 232-9600 FAX (650f) 232-9612 <br /> Consultant Company &e,*kr— tW-TN Project Name F rtwr To5eo sfA 7 <br /> Address 6 Ngrf i Mr- Vo vve 11 Flt/ �f* TOSCO Engineer (required) Vd q �� <br /> City P-e a f uVna State C Zip Code <br /> Telephone v7 7��.. 3 6 FAX # �� Site #, City, State 6191, ►,¢-7v �r��;f �¢t �k��► �/� _� <br /> Report TogotVf g r Sampler G �, R;�r � OC Data 6 Level D (Standard) E) Level C 0 Level B 0 Level A U <br /> Turnaround 0 10 Work Days ❑5 Work Days ❑3 Work Days ❑ Drinking Water Analyses Requested <br /> Time ❑ 2 Work Days ❑ 1 Work Day O 2-8 Hours ❑Waste Water <br /> CODE: ❑Misc ❑ Detect ❑ Eval ❑ Remed ❑ Demol ❑Closure ❑Other V1��pa °otio� Vtio� �o1��oe <br /> Client Date/Time Matrix # of Cont Sequoias �P Comments <br /> Sample I D Sampled Desc Cont Type Sample # <br /> 1Vl�r` 1 /q �O wiafe V'0� <br /> 2 IM� w V <br /> 3 07 <br /> 0 <br /> 4 — <br /> 5 <br /> 6 <br /> 7 <br /> 8 <br /> 9 <br /> L� <br /> 14 Cr <br /> co <br /> Relinquished By Date /q Time 151,3 Received Ouwcol, ate Lq 63\ Time f <br /> L <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 />