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U 885 Jarvis Dr Morgan Hill, CA 95037• (408) 776-9600 • FAX (408) 782-6308 <br /> . s ❑ 819 Striker AVWute 8 -Sacramento, CA 95834 - (916) 921-9600 FAX (916) 9210 <br /> �J�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 <br /> ❑ 1551 Industrial Road • San Carlos, CA 94070• (650) 232-9600 FAX (650) 232-9612 <br /> Consultant Company Project Name "r <br /> Address TOSCO Engineer(required) <br /> city i J7 f� State i -_ Zip Code f y 1 <br /> Telephone ' ��! FAX #�f Ma ,, _ rf Site #, City, State ' f j d f r - G f I r` !�.r # t�� a <br /> Report To j t _ 'L� Sampler I k i„ `�� ' t� , r' OC Data ;'© Level D (standard) ❑ Level C ❑ Level B ❑ Level A V <br /> Turnaround 0 10 Work Days P 5 Work Days ❑3 Work Days ❑ Drinking Water Analyses Requested Q` <br /> L <br /> Time ❑ 2 Work Days- C11 Work bay ❑2-8 Hours 1 <br /> ❑Waste Water <br /> 41 11 <br /> tiP�� �P%SFA <br /> Q Q <br /> CODE: ❑ Misc El Detect ❑ Eval ❑ Remed ❑ Demol Ll Closure ❑Other 14, tion , ih40 Op <br /> Client Date/Time Matrix # of Cont Sequoia's `QP�o �°� ��QP `P�� p�� co°� ' <br /> Sample I D Sampled Dese Cont Type Sample # Comments <br /> Cr <br /> m <br /> 3 65 <br /> 4 <br /> 0 <br /> 5 <br /> 6 <br /> 7 <br /> 8 <br /> 9 <br /> CU <br /> 10 3 <br /> Cr <br /> CD <br /> U} <br /> Relinquished By, f;1 r'� �p� �a ��}te{;« Dater,- Time Received By Date 6 Time I �, <br /> s <br /> Relinquished By � j� e• ;qn Date 6-f 6 tTime ;3�} Received By Date Time <br /> Relinquished By Date Time Received By -r--- ' Date Time <br /> Were Samples Received in Good Condition9 ❑Yes ❑ No Samples on fce'? ❑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 needed9 <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 />