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Tosco v <br /> v 404 N.Wiget Lane •Walnut Creek, CA 94598 (925) 988-9600 FAX (925) 988-9673 <br /> ❑ 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: <br /> 'z tiO Project Name: .o -C7 <br /> Address:6 - TOSCO Engineer (required) /� <br /> City: <br /> JC <br /> Ci State: Zip Cade; I r / S <br /> Telephone: 4% vV <br /> FAX #: Site #, City, State: 7�iro <br /> Report To: Sampler: <br /> OC Data: ❑ Levet D (standard) ❑ Level ❑ Level B ❑ Level A <br /> Turnaround 10 Work Days ❑5 Work Days ❑ 3 Work Days ❑ Drinkin Water <br /> Time: ❑ 2 Work Days ❑ 1 Work Day ❑2-8 Hours g Ana ses Requested 1 - <br /> C3 Waste Water �, %T 4 h <br /> CODE: ❑Misc. Detect. ❑Eval. U Remed. ❑Demol. ❑Closure ❑Other �,� \Q! ext y V" <br /> Client Date/Time Matrix # of Cont. Sequoia's ,hV. <br /> 1 \ <br /> Q!� <br /> Sample I.D. Sampled Desc. Cont. Type Sample # �Q� 0���� ��� J��°�`� e�CP e- Com is <br /> C <br /> C, <br /> 2. S <br /> o <br /> 3. <br /> 4- 54 t• <br /> 6- l►n.. t ¢rl 6 ! <br /> 7. <br /> 8. <br /> 9. <br /> 1a. <br /> Cr <br /> Relinquished By: Date: Time:16 ' y - <br /> Z �O Received B : Date: Time: <br /> -I'�S <br /> Relinquished By: Date: Time: Received B L <br /> y Date: Time: <br /> Relinquished By: Date: Time: Received By: Date: 1113 Time: <br /> Were Samples Received in Good Condition? U Yes ❑ No Samples on Ice? ❑Yes ❑No Method of Shipment <br /> To be completed upon receipt of report: Page_of <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, what was the turnaround lime? <br /> Approved by: Signature: <br /> Company: Date•. <br /> ti•t, <br />