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NY IJ-, It_i ii ❑885 Jarvis Drtve fel an Hill,CA 95037-(408) 776-9600-FAX(408) 782-6308 7 <br /> 819 Stnker Ave , S -Sacramento,CA 95834-(916) 921-9600-FAX(916)921-0100 I � + <br /> ❑ <br /> - 404 N Wiget Lane-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 r <br /> ❑ 1551 Industrial Road•San Carlos,CA 94070+(650) 232-9600- FAX(650)232-9612 <br /> Consultant Company C } I) f Tosco Engineer L$: Z' l I <br /> Address ! j k10 <br /> Site# 4 ( ` <br /> Cityy 0 } I State fy Zip Code11('; ) Site Address <br /> Telephone�f�� C 1 ���Fax# ' (p( <br /> (l�,1 /()Email City, State �'� <br /> Report To ) /( Sampler QC Data ❑Level D (Standard) ❑ Level C ❑Level B ❑Level A <br /> U <br /> Turnaround t10 Work ys ❑5 Work Days ❑3 Work Days Drinking Water Analyses Requested c <br /> Time ❑ 2 Work Days ❑ 1 Work Day ❑2-8 Hours ❑Waste Water �� q, <br /> E]Other <br /> Other '� O <br /> Project Coding <br /> Client Date/Time Matrix #of Cont Sequoia's ,r°� •r �O °� O �_ ?� <br /> Sample I D Sampled Desc Cont Type Sample# A,Q O O .� Comments <br /> 3 <br /> Cr <br /> 5 11 hV <br /> s lU lr3d I Ii�T )AI <br /> 7 n� 2-7 <br /> s I !Z J/ OU p �t�GCr 12(Sr <br /> I 9 0 <br /> 10 <br /> Relinquished By Date Time Received By Date q- /-C- Time /9'30 <br /> r <br /> Relinquished By ' Date Time Received B _ 'l Date Time >1 <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_ Yv1i_ 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 />