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U 819 Striker Ave , Suite 8 • Sacramento, CA 95834 • (9 t6) 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 /> U 1551 Industrial Road • San Carlos, CA 94070 * (650) 232-9600 FAX (650) 232-9612 <br /> Consultant Company G _ Protect Name <br /> Ao�e_' �<< ---- -T^ <br /> Address r 417 , ����; �' Cf S, �� _ TOSCO Engineer (required) - <br /> y State ��a Zip Code / <br /> Cit ` �, � 1,�r _ `1 <br /> Telephone p S - � FAX it �'j5 - ) ) / 7�-�"i Site #, City, State <br /> Report To <� ,( � Sampler i QC Data ;.}bevel D (Standard) U Level C U Level 8 U Level A <br /> U <br /> Turnaround �'10 Work Days U 5 Work Days U 3 Work Days U Drinking Water rAnalyses Requested <br /> Time U 7 Work Days U 1 Work Day U 2-8 Hours U Waste Water ,� %ti�°� <br /> CODE: U Misc U Detect U Eval 4XRemed U Demot U Closure �LyjOiher a a 5� o <br /> -a <br /> Client Dale/Time Matrix # of Cont Sequoia's Comments <br /> Sample 1 D Sampled Desc Cont Type Sample # <br /> 1 �-�- L T 11 Za 1L'k�! ' �' i)2 t l' O Ila <br /> _ o <br /> 3 <br /> 4 ° <br /> f } <br /> 5 <br /> 7 <br /> 9 <br /> f, o <br /> 10 Q <br /> v <br /> ( � rn <br /> Relinquished By r �'� \ Date I��,�Lf Time Received By �a��Cr�� Date Time IXY-- <br /> Relinquished By , 'Dale 1 1( Time f/'It) Received By Date Time <br /> Relinquished By Date Time Received By !si'G Date Time <br /> Were Samples Received in Good Condition? U Yes U No Samples on Ice? 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? U Yes U No If no, what analyses are still needed? <br /> 2) W the report issued within the requested turnaround time? U Yes U No If no, what was the turnaround time? <br /> Approve Signature Company <br /> i <br />