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U U 1 y'l :9 ❑ 819 Striker Avuite 8 - Sacramento, CA 95834- (916) 921-9600 FAX (916) 921-0 0 <br /> )l 404 N Wiget -Walnut Creek, CA 94598- (925) 988-9600 FAX (925) 988-96 <br /> ❑ 1455 McDowell Ivd North; Suite D - Petaluma, CA 94954- (707) 792-1865 FAX ( 792-0342 <br /> TOSCO <br /> © 1551 industrial Road - San!Carlos, CA 94070 - (650) 232-9600 FAX (650) 232-9612 <br /> Consultant Company Y - rJ 7,7G / y� v 5 {, Project Name <br /> Address C y U r r ,-cam G� •-t TOSCO Engineer (required) <br /> City State C A Zip Code cly E� JC <br /> c:7Telephone Z 5 j — 7Y S` FAX # 2 5� s S i - �'�' Site #, City, State <br /> 5S <br /> U <br /> Report To Sampler 4, �, OC Data Xevel D (Standard) ❑ Level C LlLevel B ❑ Level A , <br /> Turnaround )t,10 Work Days ❑5 Work Days ❑3 Work Days ❑ Drinking Water Analyses Requested a <br /> Time ❑ 2 Work Days ❑ 1 Work Day ❑2-8 Hours ❑Waste Water Q�, <br /> I <br /> CODE: ❑Misc Detect ❑ Eval ❑ Remed ❑ Demol ❑Closure ❑Other i <br /> Date/TimeClient <br /> Sample I D Sampled Desc Conk Type Sample' Comments <br /> # 4P `P � �P �o �o� �� <br /> y�Z <br /> 6;-/,-1 /t Z V $ 5 r o <br /> /J �_ <br /> 3 <br /> o <br /> 4 <br /> 5 E <br /> 6 E <br /> 7 <br /> a <br /> ca <br /> 9 0 <br /> 10 ch <br /> Date ,,y Time <br /> Relinquished By Date z6 Time Received 8y y,�, / f' <br /> L <br /> Relinquished By , Date vl Time Received By Date Time <br /> Relinquished By Date Time Received By Date Time <br /> Were Samples Received in Good Condition? ❑Yes ❑ No Samples on Ice? ❑Yes 0 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 ❑ 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 I Company Date <br /> I <br />