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❑ 885 Jarvis Drive• rgan Hill, CA 95037 • (408) 776-9600 • FAX (408) 782-6308 f° f�819 Striker Ave , 8 • Sacramento, CA 95834 • (916) 921-9600 - FAX (916) 921-0� a 404 N Wlget LaneTWalnut Creek, CA 94598 • (925) 988-9600 • FAX (925) 988-9673 TOSCO El1455 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 SCcor Tosco Engineer, lenj raAl Address 3oi-? kitkj,v[. k./ S'-z I, /vJ Site # City �'R ,�� ,,,,t State CA Zip Code cl Site Address �6 ,jt Telephone f ev, ) S&I-cyoo Fax# (41 ) so-1,1/30 City, State 5rv',r t,,,,, , C9 mv ReportTo C,, ., i j t,f,.,, Sampler QC Data U Level D (Standard) ❑ Level C ❑ Level B ❑ Level A ' Y C Turnaround a 10 Work Days ❑ 5 Work Days ❑ 3 Work Days ❑ Drinking Water Analyses Requested op Time ❑ 2 Work Days ❑ 1 Work Day ❑ 2-8 Hours ❑ Waste Water Other Protect Coding 4�� Client Date/Time Matrix # of Cont Sequoia's Q� 2,0 �OC� g3�a q��oG Sample I D Sampled Desc Cont Type Sample # Comments 1 W- L 30fz rf ar Sort I zxc �.c � � r•.rWac rrN,r...n. f 2 Mw-6 E 35 r � � Cr 4 MW- 6 rt5 { c°n' 5 Mw 7 0 6 -7 t to 7 7 8 p1w -7 F ?p 0 g hu-?r 15 m 10 mw -7 4 N Relinquished By Date 1 17 011 Time 16"{ Received B uC V Date Timel Relinquished By Date Time Received By Date Time Relinquished By Date Time I Received By Date Time Were Samples Received in Good Conditions ❑ 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 reported2 ❑Yes ❑ No If no,what analyses are still needed? 2)Was the report issued within the requested turnaround time) ❑Yes ❑ No If no,what was the turnaround time? Approved by Signature Company Date