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11 _ U U ti v J�. ❑ 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) 988-9673 <br /> TOSCO El1455 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 /> Project Name Company <br /> ,K G <br /> Address f e TOSCO Engineer (required) <br /> - 5ovd City J State Zip Code YS 6 WIC Q7J lfi <br /> Telephone �� S , '�� FAX # F�� — Site #, City, Slate 2 <br /> 2 <br /> Report To 5' r, S�c�J Sampler �'L OC Data eveE D (Standard) ❑ Level C © Level B ❑ Level A v <br /> _.. Re � <br /> Turnaround Work Days ©5 Work Days 0 3 Work Days C3 Drinking nested Drinking Water Y q d <br /> Time ❑ 2 Work Days 0 1 Work Day U 2-8 Hours <br /> U Was Water , ��� P�ti01 Qa�\ <br /> �a o` <br /> CODE: U M+sc U Detect ❑ Eval `�rRemed U Demol U Closure ther boa <br /> Client Date/Time Matrix # of Cant Sequoia'sQPM `eQ �p �P `�o c°� <br /> � � Comments <br /> Sample I D Sampled Desc Cont Type Sample # <br /> 1 ��- 914, 01 A v `"t o <br /> ??P- F7,J o <br /> e, cr <br /> 24 <br /> 3 3 <br /> Q <br /> 4 } <br /> 5 <br /> 6 <br /> 7 <br /> 8 <br /> T <br /> 9 d <br /> i <br /> 10 Cr <br /> Date Time Received Sy �• Date �Z'o/ Time /a a� <br /> Relinquished By r <br /> Relinquished By Date (, Time 6j Received ByAL <br /> Date Time <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 /> 1)Were the analyses requested on the Chain of Custody reported? ❑Yes ❑ No If no, what analyses are still needed? <br /> 2) the report issued within the requested turnaround timer ❑Yj O No If no, what was the turnaround time? <br /> a <br /> Apr - 01, Signature - Company to <br />