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J vVJ Jill V1.) UIIYWe <br /> U�II`' QQU((]3 J 819 Striker Av 8 • Sacramento, CA 95834 • (916) 921-9600 PAX (916) 921-861 ❑404 N Wiget LWalnut Creek, CA 94598 • (925) 988-9600 FAX (925) 988-9673 <br /> TOSCO ❑ 1455 McDowell Blvd North, Suite D • Petaluma, CA 94954 - (707) 792-1865 FAX (707) 792-0342 <br /> ❑ 1551 Industrial Road • San Carlos, CA 94070 • (650) 232-9600 FAX (650) 232-9612 <br /> Consultant Company Protect Name c u 5'02 , cf S <br /> Address y S 2, + �'f �� , TOSCO Engineer (required) �-rt- <br /> Ciry State Zip Code <br /> Telephone FAX # 97 s Site #, City, State S h,c,k`nC14(i_ m <br /> Report To ` C Sampler C, L S-7i-,J QC Data evel D (Standard) ❑ Level C ❑ Level B LI Level A U <br /> Turnaround S'10 Work Days ❑ 5 Work Days ❑3 Work Days O Drinking Water rAnalyses Requested a <br /> Time ❑ 2 Work Days ❑ 1 Work Day ❑2-8 Hours <br /> El Waste Water <br /> CODE. ❑Misc ❑ Detect ❑ Eval `p-i*med ❑ Demol ❑Closure <br /> Date/TimeClient <br /> Sample I D Sampled Desc Cont Type Sample # �P �4 \� ¢P Jo`�\° Vo Co <br /> Ik3 h z1 1 1 2 0 Y s <br /> 2 i <br /> v 1 -7 , u, <br /> 3 <br /> 0 <br /> 4 Y <br /> 5 <br /> 6 <br /> 7 <br /> d c� <br /> a <br /> s o <br /> 10 <br /> Relinquished By _ Date�Z rj ' Time I If 14 Received By Date Time a� <br /> Relinquished By Date Time Received By Date Time <br /> Relinquished By Date Time Received By Date / j Time J <br /> Were Samples Received in Good Condition? ❑Yes ❑No Samples on Ice? ❑Yes ❑ 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 ❑ No If no, what analyses are still needed? <br /> 2)Was the report issued within the requested turnaround time? ❑Yes 0 No If no, what was the turnaround time'? <br /> Approved by Signature Company Date <br />