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U 885 Jarvis Dri • Morgan Hill, CA 95037 • (408) 776-9600 • FAX (408) 782-6308 <br /> --• N(-) 000710 Cl 819 Striker Aurte 8 • Sacramento, CA 95834 • (916) 921-9600 FAX (916) 920 <br /> Cl 404 N Wiget Lane •Walnut Creek, CA 94598 • (925) 988-9600 FAX (925) 988-96 <br /> Tosco11 1455 McDowell Blvd North, Suite D • Petaluma, CA 94954 • (707) 792-1865 FAX (707) 792-0342 <br /> (�<<<� , �� - U 1551 Industrial Road • San Carlos, CA 94070 • (650) 232-9600 FAX (650) 232-96112 <br /> Consultant Company elz- I�c�r j� Project Name PA c , F- , C- 4-o e-- <br /> Address6, '7 7 TOSCO Engineer (required) -_ V a L <br /> City L , State Zip Code <br /> Telephone nl 2-j Site , City, State <br /> Report To ampler �^ L S`ta , QC Dataevel D (Standard) ❑ Level C ❑ Level B ❑ Level A <br /> Turnaround Work Days ❑5 Work Days U 3 Work Days U Drinking Water Analyses RequestedCL <br /> Time ❑' 2 Work Days ❑ 1 Work Day ❑ 2 8 Hours ❑W to Water �5,�� P�°� <br /> �a o. ` �Q <br /> CODE- ❑ Misc ❑ Detect ❑ Eval �emed O Demol U Closure Other d' ryo� tion 1y�°a a�`d, <br /> Client Date/Time Matrix # of Cont Sequoia's �eP �QP ��?"� �� � v°°��� <br /> �`` Comments <br /> Sample I D Sampled Desc Cont Type Sample # <br /> 3 (-7 ' O <br /> 4 <br /> 5 <br /> 6 <br /> 7 <br /> 8 <br /> 9 m <br /> 0 <br /> 10Cr <br /> m <br /> _ CO <br /> Relinquished By e f,/ Time ,�� Received � �- Date (/�5t Jas Time <br /> " c <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? U Yes ❑ No Samples on Ice's ❑Yes U 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 0 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 /> Approved by Signature Company Date <br />