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. N , 000,722 U 819 Striker Avelto 8 • Sacramento, CA 95834 • (916) 921-9600 FAX (916) 921-a <br /> 404 N Wiget Lar' •Walnut Creek, CA 94598• (925) 988-9600 FAX (925) 988-9673 <br /> Tosco <br /> 41455 McDowell Blvd North, Suite D• Petaluma, CA 94954 • (707) 792-1865 FAX (707) 792-0342 <br /> u 1551 Industrial Road •San Carlos, CA 94070 . 650 232-9600 FAX 650 232-9612 <br /> Consultant Company �� r— Project Name <br /> Address 7 4„f�-s',,,`�C � TOSCO Engineer(required) mtx, 6A'nL <br /> CityJ� t u� State Zip Code O n" <br /> Telephone 9 L5--FS—/r75T�5_ FAX # l��-�'r� Site #, City, State 11i 3 C <br /> Report T07[:4W t=r Sampler DLS OC Data evel D (standard) ❑ Level C ❑ Level B ❑ Level A <br /> Turnaround g10 Work Days U 5 Work Days ❑3 Work Days U Drinking Water Analyses Requ_e_ste__dJ a <br /> Time ❑ 2 Work Days U i Work Day U 2-8 Hours U Waste Water <br /> CODE: ❑Misc U Detect U Eval U Remed U Demol U Closure U Other <br /> Client Date/Time Matrix # of Cont Sequoia's wQP� �QP� `p� �ePqP Comments <br /> Sample I D Sampled Desc Cont Type Sample # �Q� ��` �1� �Q� �o�a � <br /> 1 � �l` G-yJ 3 01 A -C <br /> a <br /> 2MJ 0 2,G <br /> sv <br /> 3 O <br /> 4 0 <br /> 5 <br /> } <br /> 6 <br /> 7 <br /> 8 <br /> 9 V <br /> 0 <br /> 10 cr <br /> a� <br /> W <br /> Relinquished By Date Time Received By Date !v os Time /sem <br /> Relinquished By <<,� Date A-' .ice Time �,j'�s Received By Date oil Time <br /> Relinquished By Date Time Received By Date Time <br /> Were Samples Received in Good Condition? U Yes U No Samples on Ice? U Yes U 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 needed? <br /> 2)Was the report issued within the requested turnaround time? ❑Yes ❑ No If no, t was the turnaro nd time? 1AW <br /> Approved by Signature �t Date <br />