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❑ 819 Striker Avite 8 • Sacramento, CA 95834'• (916) 921-9600 FAX (916) 921- <br /> 4 404 N Wiget L •Walnut Creek, CA 94598 • (925) 988-9600 FAX (925) 988-96;0 <br /> Tosco ❑ 1455 McDowell Blvd North, Suite D • Petaluma, CA 94954 • (707) 792-1865 FAX (707) 792-0342 <br /> LI 1551 Industrial Road • San Carlos, CA 94070 • (650) 232-9600 FAX (650) 232-9612 <br /> Consultant Company ,7� c-', �` c�,P -Z-,,� /�/c , �, ��� Project Name vo <br /> AddressTOSCO Engineer (required) ] j <br /> S F r f rL. <br /> City �4 �1/,`y� State G Zip Code cl L/.�5f, S�d <br /> TelephoneC12 5 r j S 5 FAX # ZS�S� �_ f�., Site #, City, State �-� tt c�< IT �-� c4 T) <br /> Report To C- Lf Sampler s `, QC Data 3 Level D (Standard) U Level C U Level B ❑ Level A v <br /> Y <br /> Turnaround J,10 Work Days ❑ 5 Work Days U 3 Work Days 0 Drinking Water Analyses Requested CL <br /> Time U 2 Work Days U 1 Work Day U 2-8 Hours U Waste Water <br /> CODE. u Misc XDelect U Eval U Remed U Demol U Closure U Other �oa� <br /> Client Date/Time Matrix # of Cont Sequoia's `P0 �\P �\P �QP� e�` w�°� �(t' Comments <br /> Sample I D Sampled Desc Cont Type Sample # <br />� <br /> 0 <br /> Cr2 <br /> 3 3 <br /> 4 <br /> 5 <br /> 6 <br /> 7 <br /> 8 <br /> 9 <br /> 0 <br /> 10 Cr <br /> m <br /> U) <br /> Relinquished By --� Date�TZ Time Received By Date ` *V i Time /;O r'O a� <br /> Relinquished By Date Time Received By <br /> Date LYQ 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 U No Method of Shipment Page—of <br /> To be completed upon receipt of report <br /> 1) Were the analyses requested on the Cham of Custody reported9 U Yes U No If no, what analyses are still needed? <br /> 2) Was the report issued within the requested turnaround time? U Yes ❑ No If no, what was the turnaround time? <br /> Approved by Signature Company Date <br />