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. X'11 . vvu-zU 1 ❑404 N W .Walnut Crcak,CA 94598 (925)98B-9604 FAX (925)988-967 <br /> ig <br /> ry TOSCO <br /> L7 1455 McDos 'ivd North,Suite D•Petaluma,CA 94954• (707) 792-1865 FAX 792-0342 <br /> rx 0 1551 Industrial Road •San CaiJos, CA 94070 (M)232-9600 FAX (650)232-8612 <br /> /13 Protect Name. 4 <br /> �CE Consultant Company l4 <br /> c '--' <br /> TOSCO Engineer (required) ` M It C/ <br /> Address: c7 lge&-A- <br /> m City ` State Zip Code 1� <br /> m _ `c <br /> FAX# ! ,T.j( �'� e'�'� Site#, Clty, State I Z`� <br /> Telephone 5 5� r s�� E <br /> Sampler. QC Data level D (siandwm- 0 Level C D Level B 0 Level A <br /> Report To, P , s <br /> hAnalyses Requested n <br /> Turnaround -a10 Work Days L]5 Work Days ❑3 Work Days G Drinking tNater , , <br /> Time- 0 2 work Days O 1 WO*Day O 2-8 Hours ❑Waste Water � <br /> CODE: U mac C1Doted ❑Eval. D Remod. 0 Demo1 Q Closure Other p <br /> Chant Date/Time Matrix # of Cont. Sequoia's $ �,� Comments <br /> Sample I D milled Dese Cont Type Sample# <br /> i <br /> i <br /> m ' <br /> 0 Z• <br /> Q) 3 <br /> 0 <br /> 4 <br /> z 5 <br /> X <br /> � 6 <br /> 7 <br /> 8 <br /> 10 i <br /> Date 1 j Q Time Received By date Time l <br /> Z Relinquished BY. r 1 p <br /> z Date Time Received By Date' Time. <br /> a Relinquished Ely ' <br /> r <br /> Date Time Received By Dale Time: <br /> Refnquished By: <br /> W <br /> -JPage of <br /> 1-- Were Samples Received m Good Cordtion? ❑Yes D No Samples on Ice? ❑Yes ONO Method of StilpmeM <br /> W <br /> " To be completed upon receipt of report: <br /> the Chain of Custody reported DYes ONO if no,what analyses are still needed? <br /> i}Were the analyses requested on t <br /> 2)Was the report Issued within the requested turnaround times D Yes q No It no,what was the turnaround time <br /> Ck� Company = Date . <br /> `` Approved by _ Signature <br />