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❑ 885 Jarvis Drive• organ Hill, CA 95037 - (408) 776-9600• FAX (408) 782-6308 <br /> 0 0 7 218 819 Striker Ave , = 8 - Sacramento, CA 95834 - (916) 921-9600 • FAX (916) 921-0Is <br /> Ll 404 N Wiget Lan alnut 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 /> TOSCO p 1551 Industrial Road - San Carlos, CA 94070 - (650) 232-9600 - FAX (650) 232-9612 <br /> Consultant Company Sc�a l y. Tosca Engineer <br /> Address, � cr r fr /« C Site # < h 56 l i <br /> Cityr # State r r Zip Code ,-,,� 6 G Site Address <br /> IL rTr�r�t <br /> Telephone a! �f c yGG Fax # { 1 c,lj& City, State cry, <br /> Report Tai ,,,y r, ,,5 Sampler QC Data gLevet D (Standard) LlLevel C L) Level B LlLevel A <br /> C <br /> Turnaround ® 10 Work Days ❑ 5 Work Days ❑ 3 Work Days 0 Drinking Water Analyses Requested - o_ <br /> Time ❑ 2 Work Days ❑ 1 Work Day ❑ 2-8 Hours ❑ Waste Water <br /> L:) Other ��Rn '��� <br /> Project Coding <br /> Client Date/Time Matrix # of Cont Sequoia's Q�� .Z.o� �o ��� �eti� Comments <br /> Sample I D Sampled Desc Cont Type Sample# <br /> In ,s <br /> i <br /> 2 5s-/e 5,1 <br /> 0 <br /> 3 54-/ 60 ami <br /> C0 <br /> 'y U0r c Y64 ,ti,jibt Llaaiw� <br /> 141 U, q W..A <br /> 6 M WyniL <br /> $' .'irn Err. f ✓• �n <br /> _ Vt[A41Mi.(l <br /> 7 of-t, e to <br /> 8 Mid-0 e 15 o <br /> 9 Mu_6 ZO <br /> rn <br /> 10 BIW-o p ZS <br /> r / m <br /> Relinquished By <br /> Date" /7 a Time!C'"16 Received Q - Date TA, <br /> Relinquished By Date Time Received By <br /> U Date Time <br /> Relinquished By Date Time I Received By Date I Time <br /> Were Samples Received in Good Condition9 p Yes p No Samples on Ice? ❑ 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 p No If no,what analyses are still needed? <br /> 2)Was the report issued within the requested turnaround times ❑Yes ❑ No If no,what was the turnaround timer <br /> Approved by Signature Company Date <br />