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v46 v pctj1u binKer AVO , butte 8.5acramento, CA 95834• (916) 921-9600 FAX (916) 921-0100 <br /> *TOSCO ❑404 N Wiget LanglWalnut Creek, CA 94598 • (925) 988-9606-FAX (925) 958-9673 ' <br /> ❑ 1455 McDowell BIWorth, Suite D • Petaluma, CA 94954 • (707) 792-1865 FAX (70*2-0342 <br /> ❑ 1551 Industrial Ro—ad• San Carlos, CA 94070 • (650) 232-9600 FAX (650) 232-9612 <br /> Consultant Company ePv O PJ Protect Name �f�����, 1A- — 3,3c- T-0 <br /> Address 33 A)' m J -J'fC r TOSCO Engineer(required) eS'TDrJ <br /> City S TM State r Zip Code <br /> Telephone9�(o z 3 gDa FAX # .�� Site #, City, State qCR S roc ,J <br /> Report To <br /> P Sampler AUD C) OC Data Level D (Standard) D Level C ❑ Level B ❑ Level A v <br /> Turnaround X10 Work Days ❑5 Work Days ` ❑3 Work Days ❑Drinking Water Analyses Requested <br /> Time ❑ 2 Work Days ❑ 1 Work Day ❑2-8 Hours a- <br /> 0 Waste Water <br /> CODE: U Mtsc Detect ❑Eval ❑fleeted 0 Demol ❑Closure *ther ,` �° Sall- <br /> 13 � Q <br /> Client <br /> Date/Time Matrix #of I Cont Sequoias <br /> Sample I D Sampled Desc Cont Type Sample # �Q� �1`�+ ���� �Q�\ °�a�� � Comments <br /> 1 �7G�S � ll--L7-d a ,�►� 1 &XV <br /> 2 ml1-7g /D J 0 <br /> 3 fill -7 / _ CD <br /> _4_M <br /> 5 MW - 7eZ6 <br /> VJ -3 <br /> 8 PAW 000 <br /> �n <br /> 10 o <br /> l� rr <br /> m <br /> rn <br /> Relinquished By U) <br /> Date Time 170�b Received By II Time <br /> Relinquished By Date 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? G Yes ❑ No Method of Shipment e of <br /> pa ` _ <br /> I� 9 <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 timer _ <br /> Approved by _ Signature Company Date <br /> I + <br /> I <br />