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r� U 885 Jarvis Driv • Morgan Hill, UTA ybu.ir • OUO) 11e-yuUu • I r,n �4UO) ,o- U—�- <br /> U�� �U;3` ker <br /> i ❑ 819 StriAl Wite 8 • Sacramento, CA 95834 • (916) 921-9600 FAX (916) 921 <br /> U 404 N Wiget Lane •Walnut Creek, CA 94598 • (925) 988-9600 FAX (925) 988-96 <br /> ❑ 1455 McDowell Blvd North, Suite D • Petaluma, CA 94954 • (707) 792-1865 FAX (707) 792-0342 <br /> TOSCO U 1551 Industrial Road • San Carlos, CA 94070 • (650) 232-9600 FAX (650) 232-9612 <br /> Consultant Company C ---� � I -l~��- Project Name 1 �� <br /> Address TOSCO Engineer (required) <br /> City v StateLF <br /> Zip Code S ��# Site #, City StateTelephone 'S S ���Report To �. uL� QC Dat�evel D (Standard) ❑ Level C ❑ Level B ❑ Level A <br /> .x <br /> Analyses Requested � <br /> Turnaround 10 Work Days U 5 Work Days U 3 Work Days fJ Drinking Water Y Q <br /> Y Q Waste Water � oeS�� \QP%X \p%'C <br /> Time U 2 Work Days U 1 Work Da U 2-8 Hours <br /> CODE: isc U Detect ❑ Eval ❑ Remed ❑ Demol ©Closure ❑Other boa o� o\ �� 0CGnt ago° <br /> SampCliee I D DSampled Desrix # ofc Cont Type Sample # �a �� �`\� Comments <br /> 1 ���-i d� t4`�} X12 ° <br /> � MCr <br /> 7 t S L) <br /> 3 0 <br /> 4 } <br /> 5 <br /> 6 <br /> 7 <br /> 8 � <br /> 9 <br /> Cr <br /> W <br /> 10 uy <br /> Relinquished By DateTime )3- (o Received By Date Time � o <br /> Relinquished By i Date c; <br /> Time 2— S Received By Date Time <br /> Relinquished By Date Time Received By cam' <«� , <br /> Date � ;�' Time <br /> Were Samples deceived in Good Condition? 0 Yes U No Samples on Ice? U Yes ❑No Method of Shipment age_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? U Yes U No If no, what was the turnaround time? <br /> Date <br /> AnnrnvQrl by <br /> Siqnature _ Comoany--- - -- - ---- <br />