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❑885 Jarvis DrI organ Hill, CA 95037• (408) 716-9600• FAX(408) 782-6308 is <br /> N° 007282 �19 Striker Ave, uiter a•Sacramento, CA 95834 • (916) 921-9600- FAX (916) 921-0100 <br /> LI 404 N Wiget Lane•Walnut Creek, CA 94598• (925) 988-9600 • FAX(925) 988-9673 <br /> TOSCO El1455 McDowell Blvd North, Suite D • Petaluma, CA 94954• (707) 792-1865 • FAX (707)702-0342 <br /> ❑ 1551 Industrial Road - San Carlos, CA 94070• (650) 232-9600• FAX (650) 232-9612 <br /> Consultant Company < Tosco Engmeer: <br /> Address �� l U Site# <br /> Gtr t�,(a �c�Crt+r State �" Zip Code �S".70 Site Address 3 Z L-j <br /> Telephone r_ !�/p� Fax - G t 3 4 City, State -rOCu 7rw ( U <br /> Report To LSA �u�� Sampler 4C Data evel D (Standard) ❑Level C ❑Level B p Level A <br /> c <br /> Turnaround B'T%Work Days ❑ 5 Work Days p 3 Work Days ❑ Drinking Water Analyses Requested d <br /> Titus ❑ 2 Work Days p 1 Work Day U 2-8 Hours ❑ Waste Water <br /> Other <br /> Project Coding <br /> Client Date/Time Matrix # of Cant Sequoia's <br /> Sample I D Sampled Desc, Cont Type Sample# c O Comments <br /> V cj— l 'y6 7 to ,, <br /> 3 M W Z f, <br /> a R&I-1 ti 30 T6910k v <br /> 5fF <br /> 7 la,_7-IZ t 4r A► r.�I x <br /> 8 T <br /> 0 <br /> 9 <br /> 10 <br /> Relinquished Date f 7 Time o sj Rewrved ORate Time <br /> 917, <br /> Relinquished By Date Time Received By Date, Time <br /> Relinquished By Date Tune Received By Date Tlme <br /> Were Samples Recerved in,Good Condition? ❑ Yes ❑ No Samples on Ice? ❑ Yes ❑ No Method of Shipment Page__ ._ of <br /> To be eompfeted upon recent of report <br /> 1)Were the analyses requested on the Chain of Custody reported? ❑Yee CI foto It no,what analyses are still needed? <br /> 2)Was the report Issued withn the requested tumaround tme? ❑Yes ❑No I no,what was the turnaround time? <br /> Approved by Signature Company Date, <br />