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V U i J J b ❑ 819 Striker Ave , Suite 8• Sacramento, CA 95834 • (916) 921-9600 FAX (916) 921-0100 <br /> ❑ 404 N Wiget Lane *Walnut Croek, CA 94598 • (925) 988-9600 FAX (925) 988-9673 <br /> Tosco ❑ 1455 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 <br /> Consultant Company ����`�(L- -����� `��, 1y�tU; y Project Name -Z4 <br /> Address �`ly� ��`(�ftP J(�� "'w\t S TOSCO Engineer(required) p)\�\0 <br /> City 5#ate �(� zip Code �y �� Gv 11 a 1 c <br /> Telephone `�1�-j 1 X51-1 SS S FAX # Site #S4 %J , city, state \\�� �M\ 0A1 ('\k <br /> Report To v LCL Sampler OC Data Level D (Standard) © Level C ❑ Level B ❑ Level A U <br /> Turnaround U 10 Work Days �5 Work Days U 3 Work Days U Drinking Water Analyses Requested <br /> Time U 2 Work Days U 1Work Day U 2-8 Hours <br /> U Waste Water <br /> 1 5 Q, <br /> CODE: U Misc U Detect Eval U Remed U Demol ❑ Closure Other �`Client Date/Time �� <br /> SampleMatrix Comments <br /> I D Sampled DescCont Type Sample ## of Cont Sequoia'spP �PePoV���\ <br /> \0S 0163 N cu <br /> 0 <br /> 2 a <br /> w <br /> 3 oSAB U' <br /> 4 0 <br /> 5 <br /> 6 <br /> 7 <br /> 8 <br /> 10 <br /> to <br /> Relinquished By Date `Q t Time �1 U Received By Date (0 v C Time k3'.00 <br /> Relinquished By Date Time Received By Date Time <br /> Relinquished By Date d I Time /5/5 Received By ,�� Date ? Time <br /> Were Samples Received in Good Condition? U Yes U No Samples on Ice? ❑Yes ❑ No Method of Shipment Page_of <br /> To be completed upon receipt of report <br /> 1) Were the anaiyses requested on the Chain of Custody reported? ❑Yes ❑ No If no, what analyses are still needed? <br /> 2)Wa a report issued within the requested turnaround time? ❑Yes ❑ No If no, what was the turnaround time? <br /> �' Approved# Signature Company <br />