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t_ 002549 ❑ 819 Striker Ave., Suite 8 - Sacramento, CA 95834 - (916) 921-9600 FAX (916) 921-0100 04 N.Wiget Lane -Walnut Creek, CA 94598 - (925) 988-9600 FAX (925) 988-9673 i 1 1 55 McDowell Blvd, North, Suite D - Petaluma, CA 94954 - (707) 792-1865 FAX (707) 792-0342 TOSCO ❑ 1551 Industrial Road - San Carlos, CA 94070 - (650) 232-9600 FAX (650) 232-9612 Consultant Company: i.t.� f" Project Name: G, sr ?. c,,,� L. 1 wc� Ip1 . II �65-�0 -50 Address: 6 7 Lt 7- . �r TOSCO Engineer (required) C S City: (7cs 61; Stater Zip Code: `l'i5lS8 Q �� Telephone: �fZT- - �-- FAX #: cyz�= *90 Site #, City, State: L ��iro <-_,4 Report To: i).� Sampler: r ��„ OC Data: X�evel D (Standard) ❑ Level C LJLevel B ❑ Level A a ___J U Y Turnaround10 Work Days CJ Work Days ❑3 Work Days U Drinking Water Analyses Requested Time: �`2 Work Days ❑ 1 Work Day ❑2-8 Hours U Waste Water o' `°' '11 0- AQP Jr CODE: ❑ Misc. Detect. ❑ Eval. ❑ Remed. ❑ Demol. ❑ Closure Other �oac, °, boa �`°5` °�� 1 Client Date/Time Matrix # of Cont. Sequoia s Comments Sample I.D_ Sampled Desc. Cont. Type Sample 1. Co - Z ZS OZ + "Z GncC Q . 3 ?, X X x 0 2. W 07 3. a 4. } 5. 6. 7. 8. 9. 0 10. 17T I Cr Cn Relinquished By: Date: z Qz, Time:1-f5� Received By: Date: Time: �a m L 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 ;"a..analyses requested on the Chain of Custody reported? ❑Yes _O No If no, what analyses are still needed? 2) Was t,i;`` sport issued within the requested turnaround time? ❑Yes : ' if no, what was the turnaround time? Approved by: - -.. .... _. _._ - --- _..- -.—._._......._...�� Signature: --- Company: _ Date:_