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(1 O� �� U buo Jarvis ❑rive•Morgan Hill, l,A VOW/ • (4Ub) I/a-ftUU• r-AA �µUcst r Oe-0,3U0 <br /> 819 Striker Ave Me 8 • Sacramento, CA 95834 • (916) 921-9600 FAX (916) 921-01 <br /> ft <br /> TOSCO ❑ 404 N Wiget La afnut Creek, CA 94598 • (925) 988-9600 FAX (925) 988-9673 <br /> ❑ 1455 McDowell Blvd North, Suite D • Petaluma, CA 94954-P (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 SECOR /,vr Protect Name -f y47/ <br /> >[� <br /> Address 30tr ilii Go Ft Ppr ;4 w/CD TOSCO Engineer (required) <br /> City (okA),a State (,4 Zip Code gSG70 <br /> Telephone �q�y S61_ � FAX# (,t,, ' y&J- e l3( Site # City, State <br /> W <br /> Report To �, ,r lart e,,,; Sampler OC Data 42 Level D (Standard) ❑ Level C ❑ Level B ❑ Level A v <br /> Turnaround a 10 Work Days ❑5 Work Days ❑3 Work Days ❑ Drinking Water Analyses Requested <br /> Time ❑ 2 Work Days ❑ 1 Work Day ❑2-8 Hours °� ti a <br /> ❑Waste Water �� °ti° � <br /> vah\ OPVO <br /> CODE: ❑Misc ❑ Detect JM Eval ❑ Remed ❑ Demol ❑Closure ®Other <br /> Client Date/Time Matrix # of Cont Sequoia's <br /> Sample I D Sampled Desc Cont Type Sample # �Q�\� 0�w� �� �Q� �a ��� `5 /Comments <br /> �afo �IAA- <br /> � ;r Ot F$,+,nlfgC <br /> 1 nW-7 g- 35 f2j1Vor Sore. j r�ms� Y. l� <br /> ,r),r'f, c.oa ro <br />� 2 Mw-7t "JO l r�r +, L r� ,,v ° <br /> Cr <br /> 3 Mit- 7C L15 /� co <br /> 4 Mw-5 C 5 jZ/t'f o+ <br /> 5 <br /> r <br /> 6 Mw-5 r 15 <br /> 7 mw-5 c Za <br /> 8 n9w-5 a is <br /> 9 _ <br /> + ro <br /> 10 mw-5 e 35 <br /> Cr <br /> am <br /> r' N <br /> Relinquished By � DateZ;l7 "t Time'��(�n Received I3�r� �'}} ' i + Date I - 101 Time I(Q(O , <br /> Relinquished By Date Time Received By `f Date Time <br /> Relinquished By Date Time Received By Date Time <br /> Were Samples Received in Good Condition? ❑Yes ❑ No Samples on Ice? ❑Yes ❑ 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 ❑ Vo 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 time? <br /> Approved by Signature Company Date <br />