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❑885 Jarvis Driorgan Hill,CA 95037• (408) 776.96DO• FAX(408) 782-6308 <br /> N2 008539 16819 Striker Av , ulte 8& Sacramento,CA 9SB34• (9i6) 921-9500 a FAX(M)921.4 <br /> 11 <br /> Q 404 N.Wipet Lane-Walnut Creek,CA 94598* (925) 888-9049 - FAX (925) 988.8£73 <br /> TOSCO L)Q 1455 McDowell Blvd North, Suite D P Petaluma.CA 94954- (707) 792-1865- FAX (707) 792-0342 <br /> 1551 Induslrial Road - San Carlos,CA 94070• (650) 232-9690- FAX (050) 232-9512 <br /> ConaullerltCompany SjZ7,E,,f V#W%D 5TVQC' Tosco Engineer y ,„ <br /> Adciross. ' 10)!7 )e I z C� Site# <br /> S T► 1t _ 1 Z•ca 'SI.Z)'7'7 D&l-7-Z_ -- <br /> City State. CA�- Zip Cade 95,&17D - Site Address <br /> Telephone: 9 fib.�tiw— 0"fw> Fax N. C116T&I—Oyso - City, state- <br /> Report TO' � /' .+rc Sampler:'#1�a S ,� ,, QC Data, WLeval D (Standard) ElLevel C O Level B CI Level A <br /> Turnaround p TO work Days )Q 6 Work Daus ❑ 3 work Days ❑ Drinking water Analyses Requested a <br /> Time. j 2 Wrack Days p 1 Work Day U 24 Hours U Waste Water <br /> 4Y other <br /> Project Coding - ar .�� '�� At <br /> Cilent Daiemme matrix #of Cont Se uoras a �o� ��` � � <br /> q � Comments <br /> Sample I D Sampled Dass Cont Type Sample AN �, o <br /> SG�l�A 4� All is ISS f " � 1 cv,. . <br /> qr <br /> 2 _ <br /> 3 <br /> d <br /> 5 <br /> 7 <br /> 14. <br /> RehnquTshed BY' OateYlrk-29L Time 1610 Received By� Date -pw TimeVr <br /> Jp� <br /> RellnquTabod By Data J -i•o Timo ols c Reeeiv Date 4 Time <br /> Rolan ulslted 8y. Rate Time, Received By Date Time <br /> Were Samples flecenverl In Good Gandition? Yes 0 No Samplos un Ice? Yes ] talo Method of Shipmont�� � Page of <br /> To be cornplsted upon reccipl of report <br /> 1)were the analyses requested on Ih a Chain of Custody reporIW7 i,,,]Yes -)No If no,what analyses are star needed <br /> 2)Was the report isaeetl Witliin the requostt4l lumamund bme? ❑Yes L]leo If ria,what was the turnaround bme? v. j <br /> Approved V. Signature Company gate <br />