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V � <br /> Ll 885 Jarvis Drive - Morgan Hm, UA UbU.si - t4uu1 Id-ynUu- MA tl+uo1 !OL-VJUO <br /> 002743 ❑ 819 Striker Ave , Suite 8-Sacramento, CA 95834- (916) 921-9600 FAX (916) 921-0100 <br /> A 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) 72-1865 FAX (707) 792-0342 <br /> ❑ 1551 Industrial Road -San Carlos, CA 94070 - (650) 232-9600 FAX (650) 232-9612 <br /> Consultant Company ;, Protect Name ?ZC, T �C, ,� �„,�r ��� 14 oT o Y <br /> Vt i, �v.y, <br /> Address TOSCO Engineer(required) i <br /> City L J, State Zip Code c� <br /> Telephone 1_ I J <br /> Report To FAX # �, , ,- waw f Site #, City, State 1 ey 2 <br /> r r QC Data 11-evel D (Standard) ` O Level C Cl Level B' ❑ Level A v <br /> Sam ler A <br /> Turnaround -Ji 10 Work Days ❑5 Work Days C33 Work Days ❑Drinking Water Analyses Requested <br /> CL <br /> Time- ❑ 2 Work Days ❑ 1 Work Day 7 ❑2-8 Hours <br /> El Waste Water �'� 1 <br /> CODE: ❑ Misc ❑Detect ❑ Eval ❑Remed ❑ Demol ❑Closure) Other +41 o, <br /> Client Date/Time Matrix # of Cont Sequoia's �QP�1� �p �° ,o�ga c� r� '�\ <br /> ` �, ,� ��' C Comments <br /> Sample I D Sampled Desc Cont Type Sample # <br /> -u,l .� �.; <br /> ►cr.'zff : ff, i/i, •t� I a t,,TEAiv <br /> 2 iLf A"Mb I I X Cr <br /> X a� <br /> 4 who mf. } <br /> 5ZW <br /> 6 t <br /> 7 <br /> 8 <br /> --T7=- 1 <br /> - 1 Cr <br /> 10 `)11 L c <br /> Date 3 Time // m <br /> Relinquished By L` ,�, �,_ Date ,a f'�� Time /7 �� Received By ` "' <br /> Relinquished By Date Time Received By-- <br /> 1 , <br /> y Date Time <br /> B Date Time Received By Date Time <br /> Relinquishedy , , � <br /> Were Samples Received in Good Condition? ❑Yes ❑No 'Samples on Ice? ❑Yes ❑No Method of Shipment Page`of <br /> i <br /> To be completed upon receipt of report <br /> 1)Were the analyses requested on the Chain of Custody reportedl ❑Yes ❑ No If no, what analyses are still needed? <br /> 2)Was the report issued within the requested turnaround time? ❑Yes ❑ No If no, what was the turnaround time's <br /> Approved _Signature Company D <br />