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—,. — �—A- nw�yup� , "" v, .% 'JuI klruu) i d u-wUu • i Hr. t-tuo) !uL—UJ6. <br /> ❑ 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) 986-9673 <br /> TOSCO U 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 ��, Y.v l �� Project Name 74, 7 Coa,Lc Pi c— <br /> Address �? ( ���' TOSGD Engineer (required) 45D 5.7--- <br /> Gity—T�) State CC4- Zip Code <br /> Telephone [t Z� _ S�S`( — 7 FAX # Site #, City, State / 4 C-46 7,-,,J <br /> Report To PG�L_St Sampler QC Dataevel D (standard) ❑ Level C ❑ Level B ❑ Level A U <br /> x <br /> Turnaround ,�jM Work Days U 5 Work Days U 3 Work Days ❑ Drinking Water Analyses Requested <br /> Time U 2 Work Days U i Work Day U 2-8 Hours ❑Waste Water <br /> Dozy �P \P <br /> CODE: U Misc U Detect U Eval U Remed U Demol U Closure her °a o, o� �r� S\ a`0", <br /> Client Date/Time Matrix # of Cant Sequoia's Comments <br /> Sample I D Sampled Desc Cont Type Sample # �Q� ��`�� ��e �Q� �o�° ��o <br /> o <br /> 2 �J �f' fi li 0a P, 01, 1l 3 �a v Cr <br /> 3 1�i" o goo T <br /> 4 <br /> 5 <br /> 6 <br /> 7 <br /> 8 <br /> 9 <br /> s <br /> 10 Cr <br /> Relinquished By Date 6D Time Received By r Date ?' Time f m <br /> Y <br /> Relinquished By Date Time Received By Date Time <br /> Relinquished By Date Time Received By Date Time <br /> Were Samples Received in Good Condition? U Yes ❑ No Samples on Ice? ❑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? KYes ❑ N If no, what analyses are still needed? <br /> 2) Was the eport issued withi the r quested turnaround time? Ye ❑ lift n.9, what was the turn round time? <br /> Approved by Signature v�ompany _ � Date <br />