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w rr� r� 4.4 VVJ %jai trio WING - IVYVlypli 14ru, VI% JJV,lI 1YVVl l iV .%Jvw I rasa `YU-1 ..— —, ` 0 01221 b 819 Striker Ave , 8 • Sacramento, CA 95834 • (916) 921-9600 FAX (916) 921-01 0404 N Wiget LarflWalnut Creek, CA 94598 • (925) 988-9600 FAX (925) 988-9673 TOSCO El 1455 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 �LtbQ r" �,,�r74�r�I?z ✓")( Project Name4V e1r,7,T1Vf Address 3Gj 1 kliba¢e Pd 5k /X TOSCO Engineer (required) LD City ,,, , lalztsv"a State Gff Zip Code q�(,II ' Telephone FAX# (q r e X61-d y30 Site #, City, State <,lw L. r C Report To e t h r Sampler D Ib QC Data 'Level D (Standard) ❑ Level C ❑ Level B ❑ Level A U 1 x Turnaround IN 10 Work Days ❑5 Work Days ❑3 Work Days ❑ Drinking Water Analyses Requested Time ❑ 2 Work Days ❑ 1 Work Day ❑2-8 Hours \ \ a- ❑Waste Water � �ti� �ti� u 5\ S \e \Q r w CODE: ❑Misc ❑ Detect -5 Eval ❑ Remed ❑ Demol ❑Closure 01-0ther Client Date/Time Matrix # of Cont Se uoia's P�o�h �Paoti ePo��a '` Sample 1 D Sampled Desc Cont Type Sample # Q � � Q�\P � vo x Comments 1 Mu-5 g yo {i �� fn }f,,)1f£,67g�1 GOA cd 2 Mw-5 f 115 3 Cr 3 4 0 5 } 6 7 8 9 10 Cr a� Relinquished By �� Date 12 1.7/(" Time )`6'-Y� Received B � ,�J� Irl n� � date i� ul Time Relinquished By Date Time Received By V Date Time j Relinquished By Date Time Received By Date Time I 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 time? ❑Yes 0 No If no, what was the turnaround time? Approved by Signature Company Date