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C3 885 Jarvis Driver9 <br /> an Hill, CA 95037 - (408) 776-9600 - FAX (408) 782-6308 <br /> �} 000677 ❑ 819 Striker <br /> Ave , Suite 8 - Sacramento, CA 95834 • (916) 921-9600 FAX (916) 921-0100 <br /> ❑ 404 N Wiget Lane •Walnut <br /> North,Creek, CA 94598 -Suite D • Petaluma, CA 94954 925) 6{0) 92-1865 B8-9673 <br /> FAX (707) 792-0342 <br />� ❑ 1455 McDowell Blvd N , <br /> TOS(:o e1 D ❑ 1551 Industrial Road - San Carlos, CA 94070 • (650) 232-9600 FAX {650) 232-9612 <br /> Project Name <br /> Consultant CompanyqrAq-, <br /> TOSCO Engineer (required) e7t,> t-S To.J <br /> Address <br /> State G'� Zip Code �y$' r _ <br /> city � I,� _CD <br /> FAX # Site #, City, State �� t S F �c_k i wJ L <br /> Telephone �jz5) �Sr<" 7S-�,- 9tc) S S7 7�S�y v <br /> p ����� Q Z~ OC Data El Level D (Standard) ❑ Level C C3 Level B ❑ Level A Y <br /> Report To 5 j��� n Sam ler c <br /> n. <br /> Analyses Requested <br /> Turnaround Work Days U 5 Work Days Ll3 Work Days 0 Drinking Water 0\ <br /> Time ❑ 2 Work Days ❑ t Work Day U 2-8 Hours D Waste Water a, �aP�ti \�w <br /> U Other 1y�o�v �o� & `h�r4' ac��5 `�a��� <br /> CODE ❑ Misc i7 Detect U Eva{ med ❑ Demol ❑Closure PO P� o�� Vo�� Co menfs <br /> Client Date/Time Matrix # of Cont Sequoia's <br /> Sample I D Sampled Desc Cont Type Sample # �Q� ��`` �� �Q J° <br /> k k 513 <br /> �r`2 o <br /> Cr <br /> 1 v <br /> 2 c to e� S3 orJ ZI <br /> 3 ✓ I� ° iv <br /> 4 <br /> 5 <br /> 7 � D f��-►� <br /> 9 a� <br /> U <br /> 10 ' <br /> Im <br /> Date�I l7 Time 1;r Received By SL Date 1) 1-4 Time 13 2 <br /> Relinquished By Date Time <br /> � <br /> Date Time Received By <br /> Relinquished By Date Time <br /> Date Time Received By <br /> Relinquished By page of <br /> Condition) 0 Yes U No Samples on Ice? ❑Yes 0 No Method of Shipment <br /> `fere Samples Received in Good----------------- <br /> ,,e completed upon receipt of reportwhat analyses are stili needed? j <br /> Were the analyses requested on the Chain of Custody reported ❑Yes ❑ No If no, <br /> '3s the report issued within the requested turnaround times ❑Yes 0 No if no, what was a turnaround times Date <br /> i Signature Company <br />