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C] 885 Jarvis Drive • organ Hill, CA 95037 * (408) 776-9600* FAX (408) 782-6308 <br /> *NO- 002384 !819 Striker Ave We B • Sacramento, CA 95B34• (916) 921-9600 FAX (916) 921-010 <br /> L1404 N Wiget Lan Walnut Creek, CA 94598 • (925) 988-9600 FAX (925) 988-9673 <br /> TOSCO ❑ 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 'I ,r�/{� Protect NameT-Vsc® <br /> Address �(>�'� I f lL d�/� ���( S1 a— TOSCO Engineer (required) Ed <br /> City State LA- Zip Code a �S <br /> Telephone (70-7) 7 91— 3�5 v FAX # (7!7)731- a� Site #, City, State 61$ p 7 'f�c i�ckfZI L "A� <br /> Report To if; Sampler beep ff� �, �4�51i OC Data IN Level D (Standard) ❑ Level C ❑ Level B ❑ Level <br /> Turnaround 0 10 Work Days ❑5 Work Days ©3 Work Days ❑ Drinking Water Analyses Requestedd <br /> Time El Work Days ❑ 1 Work Day ❑2-8 Hours ❑Waste Water oar *��� \P�tia, Pati�, <br /> 0 <br /> CODE: ElMisc ❑ Detect 0 Eval C3Remed ❑Demol ❑Closure ❑Other <br /> Client Date/Time Matrix # of Cont Sequoia's `P� +AQP ���QP `�� ��° °°o Comments <br /> Sample I D Sampled Desc Cont Type Sample # <br /> 1 <br /> VW— i wake 3 �o X <br /> 2 M W— b U) <br /> 3 0 <br /> 4 <br /> 5 <br /> 6 <br /> 7 <br /> 8 <br /> 10 1 A <br /> W <br /> Relinquished By <br /> -lDate T/q Time Received y Time <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 />