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ION t.` U U J EI 819 Striker Ave ; 8 • Sacramento, CA 95834 (916) 921-9600 FAX (916) 921-0 <br /> 404 N Wiget Lane •Walnut Creek, CA 94598• (925) 988-9600 FAX (925) 988-9673 <br /> U 1455 McDowell Blvd North, Suite D - Petaluma, CA 94954 - (707) 792-1865 FAX (707) 792-0342 <br /> TOSCO U 1551 Industrial Road • San Carlos, CA 94070 - (650) 232-9600 FAX (650) 232-9612 <br /> Consultant Company Ga#/cr ai,1 _ he I ypZoS py Protect Name Ta3co �6 !3 r h 4Gij•f Alb // <br /> /73 <br /> Address ` � W- Sr errc. C-� T <br /> TOSCO Engineer (required) <br /> City 6!;h State G 4 Zip Code 01YS68 c <br /> 1 FAX # / Site #, City, State 11193 5��1�>lon C� 9 <br /> Telephone e12s 537- 7S�'"s 2S ss ' ee 8 U <br /> Sampler - QC Data Level D (Standard) U Level C l7 Level B ❑ Level A Y <br /> Report To Do &r - � <br /> Analyses Requested a. <br /> Turnaround X10 Work Days Q 5 Work Days ❑3 Work Days Q Drinking Water \ <br /> Time Q 2 Work Days u 1 Work Day Q 2-8 Hours ❑Waste Water vel oda `ft, `p <br /> CODE: ❑Misc ❑ Detect ❑Eval %Reined Q Demol 0 Closure Other <br /> Client Date/Time Matrix # of Cont Sequoia's �QP� +`� 0��� �P �\o ��c Comments <br /> Sample I D Sampled Desc! Cont Type Sample # <br /> 1 _ M V✓— 1 31/6�a► �f xd 3 Vc.f,3 0 <br /> a <br /> Cr <br /> 2 t N <br /> k � ' <br /> 3 4 o <br /> 4 <br /> 5 <br /> 6 <br /> 7 _ <br /> { <br /> 8 - <br /> 9 <br /> Cr <br /> 10 <br /> Relinquished By DTime Received By <br /> Date : t * Time if-ela <br /> G ,> / -i Time l� Received By Date TimTime_L <br /> e LS'- <br /> Date <br /> Relinquished By �l� <br /> Relinquished By <br /> Date Time Received By Date <br /> Were Samples Received in Good Condition? Q Yes Q No Samples on Ice? Q Yes Q No Method of Shipment Page_of <br /> To be completed upon receipt of report <br /> the analyses requested on the Chain of Custody reported? 1'Yes ❑ No If no, what analyses are still needed <br /> 1}Were y q w was the turnaround time <br /> 2)Was the repor sue within t ,requ` ted turnaround time9- <br /> ,r Signatu Company �� Date <br /> AaRroved by � - � <br />