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I I„I 1003000 U 819 Striker Ave uite 8 • Sacramento, CA 95834• (916) 921-9600 FAX (916) 921-0100 <br /> • U 404 N Wiget Walnut Creek, CA 94598• (925) 988-9600 FAX (925) 988-967 <br /> w L] 1455 McDowell d North, Suite D • Petaluma, CA 94954 • (707) 792-1865 FAX ( 792-0342 <br /> TOSCO <br /> El1551 Industrial Road • San Carlos, CA 94070 • (650) 232-9600 FAX (650) 232-9612 <br /> Consultant Company 'VXc_. _ Protect Name <br /> Address 7 L�722 C'o f TOSCO Engineer (required) <br /> City State Zip Codes <br /> 6-� zg 9 <br /> Telephone (� FAX # WS " �" Site #, City, State CIVU <br /> Report To 5� Sampler �'1Q� ��� �� QC Data evel D (Standard) ❑ Level C ❑ Level B ❑ Level A v <br /> Y- <br /> Turnaround0 Work Days ❑5 Work Days ❑3 Work Days ❑ Drinking Water Analyses Requested CL <br /> S <br /> Time ❑ 2 Work Days ❑ 1 Work Day ❑2-8 Wours ❑W b Water , �5�\ P��0\ QPM\ <br /> CODE: C3Misc U Detect U Eva! emed LJDemol ❑Closure Other �� \ , 4� y <br /> Client Date/Time Matrix # of Cont Sequoia's `QPM ` � p �QP� � ° Comments <br /> Sample 1 D Sampled Desc Cont Type Sample # <br /> 1 (o <br /> 2 164 <br /> Ull <br /> 3 <br /> 0 <br /> 4 } <br /> 5 <br /> 6 <br /> 7 <br /> 8 <br /> i <br /> 9 0 <br /> 0 <br /> 7 <br /> 10 - '� m <br /> Relinquished By , <br /> Dae Time Received By Date ,ZC Time <br /> Relinquished By Date Time p .-) Received By Date ,2C Time <br /> Relinquished By Date Time Received By Date Time <br /> I <br /> Were Samples Received in Good Condition? O 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? Oyes Ll 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 time? <br /> Approved by a Signature Company Date <br />