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. - _ ., �.� ,%,v o in Ou IRWI r+va, 7UIM o •0M.FdFIN MU, UA:JUo34' ku IOJ ud:I-tfovv I-AA to In) JG I-U IUU <br /> II ❑404 N Wiget Lane •Walnut Creek, CA 94598• (925) 988-9600 PAX (925) 988-9673 <br /> TOSCO ❑ 1455 McDowell Blvd North, Suite D• Petaluma, CA 94954• (707) 792-1865 FAX (707) 792-0342 <br /> it ❑ 1551 Industrial Road • San Carlos, CA 94070• (650) 232-9600 FAX (650) 232-9612 <br /> Consultant Company �1ifD J Project Name 9/)-D /1 . 1A - S-iDC*C�(DA) <br /> Addressl q 33 �, 0 Az v,r_T LSD TOSCO Engineer(required) <br /> CityeA State Zip Code <br /> ,T VTelephone 9i 3 SOC) FAX#Ir <br /> 3 Site #, City, State (`] <br /> Report ToP Sampler � � OC Data �evel D (standard) ❑ Level C k ❑ Level B EJLevel A [a <br /> Y <br /> Turnaround >6oWork Days ❑5 Work Days 0 3 Work Days O Drinking Water Analyses Requ s d <br /> Time LI2 Work Days 0 1 Work Day ; Ll 2-8 Hours ❑Waste Water a <br /> P <br /> �� �p <br /> CODE: U Misc ❑Detect ❑Eval ❑Remed ❑Demol ❑Closure 0 Other l <br /> Client Dateffime Matrix # of Cont Sequoia's � � � " `P � ��`�� <br /> Sample I D Sampled Desc Cont Type Sample# Comments <br /> 1 - , � j��Z - L 2 o� o <br /> 0 <br /> 2 <br /> 4 <br /> k 5 rn W - Ste' IN Y <br /> } 6 mW -Se v ' SII <br /> 7PAVJ-5 e�' �l Pax---) <br /> 8 VJ. e7v <br /> 9 u1�545 W, cts <br /> go 0 <br /> eT <br /> )I <br /> Relinquished By Date q) Time4700 Received BAM to "J36(36 Time I- m <br /> Relinquished By Date Time Received By Date Time <br /> Relinquished By Date Time Received By Date Time/ <br /> Were Samples Received in Goodl Condition? ❑Yes ❑No Samples on Ice? ❑Yes ❑No Method of Shipment Page—of— <br /> To <br /> fTo 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? U Yes ❑ No If no, what was the turnaround time? , T <br /> Approved byI Signature Company <br /> Dat <br />