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' ril rUl���� UUUJJdlVIaUllVV • IdlUJWC14IiWl, W% J. JJ+ <br /> {� ❑819 Striker Ave , Suite 8 •Sacramento, CA 95834 • (916) 921-9600 FAX (916) 921-0100 <br /> X404 N Wiget Lane•Walnut Creek, 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 Company1 yo o Project Name �7'oxo Farmer At-) 9 <br /> Cxtfl�r - Ran Y+�c.. s�. � <br /> Address L7-y Sic ra. G sv+ TOSCO Engineer(required) <br /> City �, State GA Zip Code `JYS'61B wirl <br /> Telephone g t 3`� S—S�� �S�S FAX # 9 Z s sS/_ 788 Site #, City, State ,moo. f//9 y Yrc�c CA T <br /> U <br /> Report To m rt�t:,G Sampler ���� QC Data Level D (Standard) C1 Level C Q Level B ❑ Level A Y <br /> Anal ses Requested a_ <br /> Turnaround 2(10 Work Days O 5 Work Days O 3 Work Days ❑ Drinking Water y <br /> Time- O 2 Work Days 01 Work Day O 2-8 Hours 0 Waste Water <br /> CODE: © Mist ❑Detect O Eval '�Remed O Demol 0 Closure Other boa , �� oo <br /> Client Date/Time Matrix #of Cant Sequoia's `QPM �Qa �,�" �� ��� ��° Comments <br /> Sample I D Sampled Desc Cont Type Sample# ca <br /> aas�w' 3�,� at Nva 3 ve45 0I � '� <br /> 0 <br /> 2 Ct) <br /> 3 c <br /> 4 <br /> 5 <br /> 6 <br /> 7 <br /> 8 i <br /> 9 <br /> I <br /> 10 <br /> Relinquished By <br /> Date Time Received By,,,, Date 3 Time <br /> Relinquished By Date/�Z— <br /> z7/ Time/y7/ Received By Date Time - <br /> Relinquished By Date Time Received By Date Time <br /> Were Samples Received in Good Condition? O Yes O No Samples on Ice? 0 Yes ❑No Method of Shipment Page,of <br /> To be completed upon receipt of report <br /> ere the analyses requested on the Chain of Custody reported? ❑Yes ❑ No If no, what analyses are still needed? <br /> lWas the report issued within the requested turnaround timed s © No If no, what was the turnaround time? <br /> Anr% m+orl by --- Signature Company Date <br />