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❑ 885 Jarvis Drive • Wrgan Hill, CA 95037 • (408) 776-9600 • FAX (408) 782-6308 N2 008001 ❑ 819 Striker Ave., 5 < :;;8 • Sacramento, CA 95834 • (916) 921-9600 • FAX (916) 921 01' N )4 404 N. Wiget Lane •`Vllalnut Creek, CA 94598 • (925) 988-9600 • FAX (925) 988-9673 '~ OSCO :11455 McDowell Blvd. North, Suite D • Petaluma, CA 94954 • (707) 792-1865 • FAX (707) 792-0342 ❑ 1551 Industrial Road • San Carlos, CA 94070 - (650) 232-9600 • FAX (650) 232-9612 Consultant Company: '� L�i�� , /ve / ,3. 1/ Tosco Engineer: �� c Address: -pt_ y f �; r rc C.f Site #: 11 19:5- City: 9:5-City: j r State: Zip Code: cy y_-6, Site Address: 16 Sa¢ S� 64 = %5- Telephone:., ' 5- Telephone:., �� S Fax#:9�5- 5!- �g t;g City, State: U Report To: L Sampler: n �` f OC Data: Level D (Standard) ❑ Level C ❑ Level B ❑ Level A Y _C Turnaround ' j 10 Work Days ❑ 5 Work Days ❑ 3 Work Days ❑ Drinking Water Analyses Requested IL Time: /❑` 2 Work Days ❑ 1 Work Day ❑ 2-8 Hours ❑ Waste Water Q� Other _0T0 Project Coding: � � �` ��lb 14 5�1 ca C,Q Client Matrix Cont. Sample �e� �o\ �pvO��cO �O Comments Sample I.D., Sampled Cont. Type Pe # 1. fzsIce Pic; _E X X 2. Da It 3. -3 rr o Cr 4. 't ?L c� 5. o 6. 7. 8. 0 9. Cr a� 10. a� Relinquished By: �T Date:zh s'�Z Time: '1L-S`C-1 Received By: Date:. Time: Relinquished By: Date: Time: Received By: Date: Time: Relinquished By: Date: Time: Received By: Date: Time: Were Samples Received in Good Condition? ❑ Yes ❑ No Samples on Ice? ❑ Yes ❑ No Method of Shipment Page of To be completed upon receipt of report: 1) Were the analyses requested on the Chain of Custody reported? ❑Yes ❑ No If no,what analyses are still needed? 2) Was the report issued within the requested turnaround tirne? ❑Yes U No If no, what was the turnaround time? Approved by: Signature: _____ _ __ _......... T Company: Date: