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4 i 1 11 U U tidy Jarvis Drive• rgan Hill, CA 95037 - (408) 776-9600• FAX (408) 782-6308 . <br /> v 0 ❑819 Striker Ave , 8- Sacramento, CA 95834- (916) 921-9600 FAX (916) 921-010, �F <br /> ❑ 404 N Wiget Lane7Walnut Creek, CA 94598 • (925) 988-9600 FAX (925) 988-9673 <br /> Tosco ❑ 1455 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 /> Consultant Company Y*j -A� Project Name Ct` c� � <br /> Address 6 � j- if L TOSCO Engineer (required) <br /> City b • State Zip Code SZ2S L tea D q L1 &Q <br /> Telephone - �( _ '7 'S FAX # z�.fir_ V9 Site #, City, State 4' G a! <br /> Report To ���-� Sampler 5 QC Data LI Level D (Standard) ❑ Level C El Level B LI Level A U <br /> Y <br /> Turnaround f-Q40-Work Days ❑5 Work Days ❑3 Work Days ❑Drinking Water Analyses Requested <br /> Time. ❑ 2 Work Days ❑ 1 Work Day ❑2-8 Hours <br /> ❑Waste Water 0 a,ery QP�ti <br /> CODE: ❑Misc ❑Detect ❑ Eval- A&ftmed ElDemol (a Closure y � <br /> adL ° <br /> Client Date/Time Matrix # of Cont Sequoia's `��,��� �� Comments <br /> Sample I D Sampled Desc Cont Type Sample # �Q� ��`� ��� �Q� �o`a 0 <br /> 0 <br /> 2 oCr <br /> 3 0 oa N <br /> 3 <br /> 4 <br /> 5 1 <br /> 6 <br /> 7 [ <br /> 8 <br /> 9 «: <br /> 0 <br /> 10 <br /> v <br /> a� <br /> N <br /> Relinquished By Date Zo a'' Time Received By Date �� Time /dye/- <br /> Relinquished <br /> dy Relinquished By Date �• (� Time S Received By Date Time <br /> Relinquished By Date Time Received � ?of-C Dak-0/00 Time t S 0_? <br /> Were Samples Received in Good Condition? ❑Yes ❑No Samples on Ice? ❑Yes O 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 stall needed? <br /> 2)Was the report issued within the requested turnaround time? ❑Yes ❑ No If no, what was the turnaround time? <br /> Approved by Signature Company Date <br />