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1 <br /> 0 01176 ;W819 Striker Ave , S*• Sacramento, CA 95834• (916) 921-9600 FAX (916) 921-0100 40 <br /> Tosco El404 N Wiget Lane •Walnut Creek, CA 94598• (925) 988-9600 FAX (925) 988-9673 <br /> L] 1455 McDowell Blvd North, Suite D• Petaluma, CA 94954 • (707) 792-1865 FAX (707) 792 0342 <br /> U 1551 Industrial Road• San Carlos, CA 94070 • (650) 232-9600 FAX (650) 232-96��1//2 <br /> Consultant Company Cv px- Protect Name C.� l es f- y3 7 ,F. 41;w- _ <br /> Address D 17q7 -5j�-t4 � 15U, Yet J TOSCO Engineer (required) brGk- <br /> City 6/jn State z (!�-�`t Zip Code 9yrdS <br /> Telephone 7ZJ-'5'S/-75S5 X I?/ FAX # V25--,561- 7JM Site #, City, State Or$ 7 - :54-ockfoti <br /> Report Toga— Sampler;4211a'f QC Data Level D(Standard) ❑ Level C G Level B U Level A v <br /> Turnaround U 10 Work Days AC5 Work Days U 3 Work Days U Drinking Water Analyses Requested c <br /> Time U a <br /> 2 Work Days U 1 Work Day U 2-8 Hours ❑Waste Water , , , <br /> ❑Other <br /> CODE: U Mise U Detect U Eval jd Remed U Demol U Closure ,h�� <br /> Al.�o mXPy� <br /> Client Date/Time Matrix # of Cont Sequoia's `PeID +`p %r Sample I D Sampled Desc Cont Type Sample # <br /> Comments <br /> 1 /t1 -1 Z 2 -ityl a i-m Z VoA X X1 3ioLtz44nt ca <br /> 0 <br /> 2 r!- 657 1 -ow I I X X X t3 <br /> 3 - 1- !1 -08� K x �' <br />� � 3 <br /> 4 0 <br /> 5 <br /> 6 - 60 -aq <br /> 7 _Qq � -- <br /> 8 <br /> 9 <br /> 0 <br /> 10Ccr <br /> a� <br /> Relinquished By Date Time �Q� Received to <br /> r <br /> Relinquished By Date Time Received By Date Time <br /> Relinquished By Date Time Received By Date Time <br /> Were Samples Received in Good Condition? U Yes U No Samples on Ice? ❑Yes U 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? Lt Yes U No If no, what analyses are still needed <br /> 2) Was the report issued within the requested turnaround time's U Yes U No If no, what was the turnaround time? <br /> Ar)nrnvpd by Sionaiti vp rmmnnnv rintp <br />