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❑819 Striker Ave , Suite 8 Sacramento, CA 95834 • (916) 921-9600 FAX (916) 921-0100 <br /> 404 N Wiget Lane•Walnut Creek, CA 94598• (925) 988-9600 FAX (925) 988-9673 <br /> Tosco 111455 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 a <br /> Consultant Company Galjl cr an - =he Iyo2o5- <br /> o� Project Name Tosco W l3rv-ticr! <br /> Address ` � �f� S�errc. �.� .]rc. fc �' TOSCO Engineer(required) w, <br /> City State G4 Zip Code 9Ys68 <br /> Telephone q2S /_ �S"ss FAX # 2S SSI 88 8 Site #, City, State 11193 5-4-pck�on Cil a <br /> Report To D0 cG Sampler OC Data Level D (Standard) ❑ Level C ❑ Level B ❑ Level A v <br /> Y � <br /> Turnaround X10 Work Days ❑5 Work Days 0 3 Work Days ❑Drinking Water Analyses Requested C <br /> Time 0 2 Work Days ❑ 1 Work Day ❑2-8 Hours01a <br /> 13Waste Water l ��� Q Pati' "all, <br /> CODE: ❑Misc Ell Detect 0 Eval %Remed 0 Demol ❑Closure 1I Other � <br /> Client Date/Time Matrix # of Cant Sequoia's `P� �° ��" ��� 1��'0`� �W° Comments <br /> Sample I D Sampled Desc Cont Type Sample # <br /> 1 M �+✓-� l 31�c1e Nad 3 ,"-I 1 <br /> 0 <br /> 2 Cr <br /> 3 U) <br /> 4 0 <br /> 5 } <br /> 6 <br /> 7 <br /> 8 <br /> 9 � <br /> o <br /> 10 <br /> Cr <br /> Relinquished By Date 206/', Time Received By Date 3 ! Time /f5Ka <br /> L <br /> Relinquished By �l� Date, / -/ Tirne/,��1(--* Received By Date Time s <br /> Relinquished By Date Time Received By Date Time <br /> Were Samples Received in Good Condition? 0 Yes ❑No Samples on lce? ❑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 needed? <br /> 2) W1a report issued within the requested turnaround time? L)Yes No If no, what was the turnaround time? <br /> O proved Signature Company <br />