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t> �+ VVUauains viirGIMulydil nisi, UA VOUJI • k4utf) 1.0-ybUU0 t-AX(408) 782-6308 <br /> t V Q© ❑819 Striker Suite 8 Sacramento CA 95834 (916) 921-9600 FAX (916) 92 0 <br /> 0 L1404 N WigeWe•Walnuf Creek, CA 94598•(925) 988-9600 FAX (925) 988-96W <br /> TOSCO ' C3 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 •-',au y Project Name <br /> Address' f, , ��:" zw� r' ,�w ��` TOSCO Engineer(required) <br /> City r _ , , State '',�, Zip Code <br /> } <br /> Telephone- FAX# QD <br /> ite# Cis State v <br /> Report To f 3 Sampler �� , � s L QC Data'� ❑ Level D t5tandard) ❑ Level C ❑ Level B O Level A v <br /> x <br /> Turnaround0 Work Days El Work Days ❑3 Work Days 0 Drinking WateI ? Analyses Requested <br /> I a <br /> I Time• 2 Work Days ❑ 1 Work Day ❑2-8 Hours p Waste Water, AN <br /> Pqr � � <br /> CODE: 0 Misc ❑Detect Xtva! ❑Remed ❑Demol ❑Closure her <br /> Client DateMme Matrix #of Cont Sequoia's <br /> Sample I D Sampled . Desc Cont Type Sample# ,�`��; 0i' ,��� ao�` Comments <br /> 2 <br /> 3 co <br /> 4 <br /> 5 , <br /> 6 �I <br /> 7 <br /> � f F <br /> 9 <br /> o <br /> 10 I Cr <br /> Relinquished By Date f'M Time Received By `�,,% , •r( f` Date ! --2 Time <br /> Relinquished By Date Time Received By q Date Time <br /> 1� k <br /> Relinquished By Date Time Received By '' Date Time <br /> Were Samples Received in Good Condition? ❑Yes ❑No Samples on Ice? d'Yes U"No I'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 ❑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 time? <br /> Approved by Signature 1f Company Date <br />