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tj (zo.J jaiV10 v1{va 1riuryair 171111, vP►vuVai - t-FVo) 110-VQVV - ✓rMA t4V8) 104-0,WC <br /> a 0 7 2 3�24 x}:$19 Striker Ave , Suite 8 • Sacramento, CA 95834 - (916) 921-9600• FAX (916) 921-0100 <br /> ❑404 N. Wiget Lane•Walnut Creek, CA 94598• (925) 988-9600- PAX (925) 988-9673 <br /> TOSCO ❑ 1455 McDowell Blvd North, Suite D - Petaluma, CA 94954- (707) 792-1865 - FAX(707) 792-0342 <br /> L) 1551 Industrial Road - San Carlos, CA 94070 • (650) 232-9600- FAX (650) 232-9612 <br /> Consultant Company Tosco Engineer <br /> Address � � Site # J 3 <br /> CitykZ <br /> State r Zip Code ?? G U Site Address ZG t i.J /�,,rr•�r,z C moi. •� <br /> e <br /> Telephone /_ G C f Fax# G G c 3 0 City, State <br /> Report To 5, �� Sampler /err „✓� Iso/ QC Data mel t,,4 andard) p Level C ❑ Level B ❑ Level A ,t <br /> c <br /> Turnaround R-M Work Days ❑ 5 Work Days ❑ 3 Work Days p Drinking Water Analyses Requested Q- <br /> Time p 2 Work Days ❑ 1 Work Day ❑ 2-8 Hours ❑ Waste Water <br /> OtherrO� x'O <br /> Project Coding <br /> Client Date/Time Matrix # of Cont Sequoia's �Q�� Q��\ �oc� ���o �O Comments <br /> Sample I D Sampled Desc Cont Type Sample# o <br /> 3 M w- l� <br /> 4 fif- A 3U i 't Tf0°ter co <br /> 6 KO-1 30 yt z u } <br /> 7 w- zR . 4f Ai Tr c <br /> 8 <br /> 9 <br /> 10 co <br /> Relinquished Date 77 Time Received r0k oDatek( Time 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 Ices (3 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? (a Yes ❑ No If no,what analyses are still needed? <br /> I <br /> 2)Was the report issued within the requested turnaround time? ❑Yes ©No If no,what was the turnaround time? <br /> Approved b9ft Signature Company Date <br />