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❑ 885 ,Jarvis Drive • Morgan Hill, CA 95037 • (408) 776-9600 • FAX (408) 782-6308 <br /> NO- 000721 ❑ 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 v 1455 McDowell Blvd North, Suite D * Petaluma, CA 94954 • (707) 792-1865 FAX (707) 792-0342 <br /> U 1551 Industrial Road • San Carlos, CA 94070 • (650) 232-9600 FAX (650) 232-9612 <br /> Consultant Company pw: A , Protect Name p o — <br /> TOSCO Engineer (required) <br /> Address s--�n�0 ,�C i� ,-�-L <br /> City J State cillaIrZip Code <br /> Telephone 25 S FAX # � 2,-W( _ 7� Site #, City, State ( S c_L i <br /> I U <br /> Report To Sampler o ( Ci QC Data �evel D (standard) ❑ Level C ElLevel B ❑ Level A <br /> Turnaround �o Work Days El Work Days U 3 Work Days Cl Drinking Water Analyses Requested <br /> Time ❑ 2 Work Days LJ1 Work Day ❑2-8 Hours C3 Waste Water QP�ti`°, <br /> CODE: ©Misc ❑ Detect U Eval Remed ❑ Demol LL] CIO sure Wi[3ther <br /> Client Date/Time Matrix # of Cont 's'equoia s �P�� ��QPa ��°� �QP�o ���o`� ���°�\ Comments <br /> Sample I D Sampled Desc Cont Type Sample # <br /> 1 � c Z5 IO Mk "` O �r r o <br /> C Cr <br /> 3 uGa <br /> 3 <br /> o <br /> 4 <br /> 5 <br /> 6 <br /> ov <br /> 7 17 <br /> 8 <br /> 9 c° <br /> 0 <br /> '10 Cr <br /> a� <br /> rn <br /> Relinquished By Date ,o Time � Received By �+ Date 10 26 0 Time [ m <br /> Relinquished By Date Time Received By Date Time <br /> I <br /> Relinquished By Date Time Received By Date Time <br /> ere Samples Received in Good Condition? 0 Yes ❑ No Samples on Ice? ❑Yes ❑ No Method of Shipment Page A of <br /> To be completed upon receipt of report <br /> 1)Were the analyses requested on the Chain of Custody reported? U Yes ❑ No If no, what analyses are still needed? <br /> 2)W he report issued within the requested turnaround time? ❑Yes C3 No if no, what was the turnaround time? <br /> I <br /> proved Signature Company I <br />