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4 U U 1,b O ❑ 819 StrikerAL, Suite 8 -'Sacramento, CA 95834- (916) 921-9600 FAX (916) 9 100 <br /> 11 <br /> • 404 N Wtgqpne -Walnut Creek, CA 94598 - (925) 988-9600 FAX (925) 988- <br /> TOSCO ❑ 1455 McDowell Blvd North, Suite D - Petaluma, CA 94954- (707) 792-1865 FA 07) 792-0342 <br /> ❑ 1551 Industrial Road- San Carlos, CA 94070- (650) 232-9600 FAX (650) 232-9612 <br /> Consultant Company )c✓ << -1i,1C ' P _ G Project Name /,�,0 t�vu.�tr J 13LU I3 <br /> .teAddress �, �� r�r�ti �� 5�„ r '3_ TOSCO Engineer (required) r war o <br /> City State A Zip Code <br /> Telephon .f z 5 s I - 7Ss FAX # 2,- SS-I-3 gga, Site #, City, State 111 S epe_k 1 oh C14 <br /> Report To � �G� Sampler M QC Data V Level D (Standard) ❑ Level C ❑ Level B ❑ Level A v <br /> x <br /> Turnaround �10 Work Days ❑5 Work Days ❑3 Work Days C] Drinking Water Analyses Requested <br /> Time ❑ 2 Work Days © 1Work Day ❑2-8 Hours ❑Waste Water ��1 %I <br /> CODE: v Misc Detect ❑ Eval ❑ Remed C3Demol 0 Closure ❑Other oa <br /> Client Date/Time Matrix # of Cont Sequoia's �P� `Pa \P �QP� � �0��� u <br /> Comments <br /> Sample I D Sampled Desc Cant Type Sample # � \ ` � <br /> 111 <br /> 1 13-- o <br /> 2 13 <br /> to <br /> 3 ~/4, 1 <br /> 4 Her } <br /> 5 t3 -1 -15` mA <br /> 6 <br /> 7 <br /> i <br /> - 9 - <br /> C <br /> 10 3 3 :�/� Q <br /> ' ' a <br /> Relinquished By Date z6 c,/ Time Received By Date <br /> "C A Time /,}`VV_t� 1. <br /> s <br /> Relinquished By ��,r Date L/,ZC�•'I Time /C�'� Received By Date Time <br /> Relinquished By Date Time Received By Date Time <br /> i <br /> Were Samples Received in Good Condition? U Yes U No Samples on Ice? U 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 U No If no, what analyses are still needed? <br /> 2) Was the report issued within the requested turnaround time'2 ❑Yes ❑ No If no, what was the turnaround time? <br /> Approved by Signature Company Date <br />