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❑ 885 Jarvis Drivloorgan Hill, CA 95037 - (408) 776-9600 - FAX (408) 782.6305 <br /> N° 0 O 7 2 4 6 ;d 819 Striker Ave ite 8 - Sacramento, CA 95834 - (916) 921-9600 , FAX (916) 9210 <br /> ❑ 404 N Wiget Lane - Walnut Creek, CA 94598 - (925) 988-9600 - FAX (925) 988-9673 <br /> TOSCO Ll1455 McDowell Blvd North, Sude D - Petaluma, CA 94954 - (707) 792-1865 - FAX (707) 792-0342 <br /> CO ❑ 1551 Industrial Road • San Carlos, CA 94070 - (650) 232 9600 - FAX (650) 232-9612 <br /> co Consultant Company SrCOlZ Jnr rv,�nanr� L Tosco Engineer EV QilGSrOAJ <br /> IL <br /> Address 3017 KtL(oOR-C!zd str"00 Site # -ro500 # ?,6,7/ ('Grrele k <br /> City Anivc+D 6 OO."q State GQ Zip Code qS-(.70 Ste Address 2100& r oti <br /> c <br /> Telephone tgtb)8b1-ogdD Fax q ejr,)8b1-dgjw City, State 5-meorclu, CR <br /> U <br /> Report To Cci1Yr 11.11AmS Sampler D 1f,4gP CC Data WLevel D (Standard) ❑ Level C ❑ Level B ❑Level A ' <br /> c <br /> Turnaround 10 Work Dayse5 Work Days ❑ 3 Work Days ❑ Drinking Water Analyses Requested a- <br /> Time, oa 2 Work Days ❑ 1 Work Day ❑ 2-8 Hours ❑ Waste Water o Q <br /> In 0Cher ,`��. 0,x'01 ti f0 <br /> Project Coding ts <br /> Client Date erne Matrix # of Cont Sequoia's �� �� �� ��p��P <br /> Sample I D Sampled Desc Cont Type Sample k � �Q� ���'` � Comments <br /> 1 SSC IZhy e1 Si7i L Zxascc <br /> l � -f� ea M 12 <br /> 2 rd <br /> 3 <br /> 0 <br /> �i <br /> 4 N <br /> 5 0 <br /> 6 <br /> U 7 <br /> Q <br /> Ln <br /> e o <br /> 9 Cr <br /> a� <br /> w 10 � <br /> N � <br /> u C <br /> a- Relinquished By DB42 17 1 TimefC Received 8 ate Tim (O—� <br /> m Relinquished By Date Time Received By Date Time <br /> m <br /> Relinquished By Date Time Received By Date Time <br /> Were Samples Received in Good Conddion2 p Yes ❑ No Samples on Ice? ❑ Yes ❑ No Method of Shipment Page of <br /> U To be completed upon receipt of report <br /> A 1)Wero fine analyses requested on the Chain of Custody reported? ❑Yes ❑ No li no,wwhal analyses are still needed? <br /> 2)Was the repwl Issued%vdhin the requestrsd turnaround 11m a? ❑ Yes ❑ No i1 no,what was iihe turnaround time? <br /> Approved by Signature Company Date <br />