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N t-1 0 0 4 4.5 2 U 819 Striker Ave , Suite 8• Sacramento CA 95834 • (916) 921-9600 FAX (916) 921-0100 <br /> U 404 N Wiget Lane •Walnut Creek, CA 94598• (925) 988-9600 FAX (925) 988-9673 <br /> Tosco U 1455 McDowell Blvd North, Suite D • Petaluma, CA 94954 • (707) 792-1865 FAX (707) 792-0342 <br /> CJ 1551 Industrial Road • San Carlos, CA 94070 • (650) 232-9600 FAX (650) 232-9612 <br /> Consultant Company � ,�,� ,,�_ Project Name p "� C.;F i C— <br /> Address G 7 �, 2/� �,.} �,_`�� J TOSCO Engineer (required) S r <br /> City�J Stateciac— Zip Code 9 L, � Jtr <br /> Telephone `' �, �� FAX # 9 T '�� j Site #, City, State c'G W <br /> J <br /> OC Data evel D (Standard) Ll Level C ❑ Level B 0 Level A C3 <br /> Report To �7~. ��(f 5TC"J Sampler ' e S <br /> Turnaround >-<1-0 Work Days ❑5 Work Days ❑3 Work Days U Drinking Water Analyses Requested ti <br /> Time U 2 Work Days U 1 Work Day U 2-8 Hourset <br /> Water <br /> CODE: U Misr, U Detect U Eval erred U Demol U Closureer e boa a�`y ago° <br /> Client Date/Time Matrix # of Cont Sequoia's tiQP �`�pa �.�ap`� �QP�° �\ w° Comments <br /> Sample I D Sampled Desc Cont Type Sample # <br /> Pl o <br /> .II) �.. (b� _ Ale, <br /> 14 , <br /> 3 � <br /> 0 <br /> 4 r <br /> 5 <br /> 6 <br /> 7 <br /> 8 <br /> 9 0 <br /> 10 ' m <br /> Relinquished By Dat j/G/ Time Qr Deceived By <br /> • Date / 01 Time /-1"-TV 0 <br /> L <br /> Relinquished By f Date j/V1 Time CL Received ey Date Time 3 <br /> Relinquished By Date Time Received By Date Time <br /> Were Samples Received in Good Condition? U Yes U No Samples on lce? U Yes U No Method of Shipment Page_of <br /> To be completed upon receipt of report <br /> r 1)Were the analyses requested on the Chain of Custody reported? ❑Yes U No If no, what analyses are still needed? <br /> 2) W* report issued within the requested turnaround time? ❑Yes 4V If no, what was the turnaround time? _ <br /> l Approved by Signature Company <br />