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.1 VvJ J41 vIS LfYIVV IYwll�,ul� � 1111, V� � .JJV�I' , �`-'1 ' ' ` � ....� � <br /> • <br /> NO- 000718 ❑819 Striker Avete 8• Sacramento, CA 95834 • (916) 921-9600 FAX (916) 921-0AL <br /> LI 404 N Wiget LJWK Walnut Creek, CA 94598 • (925) 988-9600 FAX (925) 988-967 <br /> ❑ 1455 McDowell Blvd North, Suite D • Petaluma, CA 94954• (707) 792-1865 FAX (707) 792-0342 <br /> TOSCO U 1551 Industrial Road •San Carlos, CA 94070• (650) 232-9600 FAX (650) 232-9612 <br /> Consultant Company ✓, Protect Name L <br /> � TOSCO Engineer(required) �7 <br /> Address ,�Jq 7 <br /> City �� 1 State Zip Code ��r� <br /> Site #, City, State <br /> Telephone Q 2�, �f FAX # z�'� 7/ ��� <br /> Report To SI L p LS Tti Sampler - Level D (Standard) U Level C LlLevel B U Leve! A <br /> U <br /> Y <br /> Re � <br /> Turnaround El 10 Work Days Work Days LI3 Work Days Ll Drinking Requested Drinking Water y q a <br /> Time ❑ 2 Work Days ❑ 1 Work Day 112-8 Hours U Waste Water °o\ <br /> CODE: ❑Mlsc D Detect ElEval �emed ElDemol ❑Closure her h�� , ��14 ON <br /> Client Date/Time Matrix # of Cont Sequoia's �P ��Qp �� `�� �� ��° Comments <br /> Sample I D Sampled Desc Cont Type Sample # �Q� ��`� ��� �Q� J°�a •��0 <br /> A4re ( r4e, 01A s o <br /> 2 flu Q 6 W <br /> 3 0 <br /> 4 <br /> 5 <br /> 6 <br /> 7 <br /> 8 <br /> 9 0 <br /> Cr <br /> 110 c(D <br /> Relinquished By r <br /> Date f j Time �5� Received By Time <br /> Relinquished ByDante Time <br /> � <br /> '�'� Dale 11 OV Ttme�s% 2F <br /> Relinquished By lime ecejved y �,v+C <br /> Were Samples Received in Good Condition? ❑Yes ❑No Samples on Ice? ❑Yes ❑No Method of Shipment Page—L 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) Was the report issued within the requested turnaround time? ❑Yes ❑ No If no, what was the turnaround time9 <br /> Approved by Signature Company Date <br />