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❑885 Jarvis Dnve•Morgan Hill, CA 95037• (408) 71b-UbUU• t-AA V+U01 r Oe"o <br /> N 0 002996 ❑ 819 Striker Ave, Suite 8•Sacramento, CA 95834• (916) 921-9600 FAX (916) 921-0100 <br /> ❑404 N Wiget Lane•Walnut Creek, CA 94598• (925) 988-9600 FAX (925) 988-96735 <br /> ToscoU❑ 1455 McDowell Blvd Narth, Suite D • Petaluma, CA 94954•(707)792 186 FAX (707) 792-0342 <br /> 1551 Industrial Road•San Carlos, CA 94070• (650) 232-9600 FAX (650) 232-9612 <br /> Consultant Company " Project Name <br /> v S, f t- TOSCO Engineer (required) Z. <br /> Address <br /> City" d State Zip Code 5-4 <br /> Site#, City, State C� <br /> Telephone Z�. �� 7 FAX # /L �_ 74 ` <br /> U <br /> Report To Sampler p CC Data evel D (standard) ❑ Level C ❑ Level B ❑ Level A Y <br /> Analyses Requested a <br /> Turnarourork Days ❑5 Work Days ❑3 Work Days ❑Drinking Water P ` \ <br /> Time 2 Work Days ❑1 Work Day ❑2-8 Hours ❑Wa Water <br /> isc ❑Detect ❑Eval emed ❑Demol ❑Closure other <br /> CODE: L3 M <br /> Client * DateMme Matrix #of Cont Sequoia's <br /> Sample I D Sampled Desc Cont Type Sample# , J <br /> ° <br /> 2k <br /> 20* <br /> 3 <br /> 3 ° <br /> 4 } <br /> 5 <br /> 6 <br /> 7 <br /> 8 <br /> o <br /> 6 <br /> 0 <br /> 10 <br /> C0 <br /> ed B Da e / Time Received By Date C°� t Time 3� <br /> Relinquish y Time <br /> ater? Time Received By Date <br /> Relinquished <br /> shed By � Time <br /> Relinquished By <br /> Time Received By Date <br /> Page—of <br /> Were Samples Received in Good Condition? C]yes ❑No Samples on Ice? 0 Yes ElNo Method of Shipment <br /> To be completed upon receipt of report <br /> 1)Were the analyses requested on the Chain of Custody reported?❑Y❑s e0 No No If no, what analyses are <br /> the urnaroundlt meed <br /> 2)Was the report issued within the requested turnarou Company Date - <br /> - Appro Signature <br />