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U U 1:1:1 U U 819 Striker Ave , Suite 8 - Sacramento, CA 95834 - (916) 921-9600 FAX (916) 921-0100 <br /> 404 N Wiget Lane -Walnut Creek, CA 94598 - (925) 988-9600 FAX (925) 988-9673 <br /> TOSCO U 1455 McDowell Blvd North, Suite D - Petaluma, CA 94954 - (707) 792-1865 FAX (707) 792-0342 <br /> U 1551 Industrial Road - San Carlos, CA 94070 - (650) 232-9600 FAX (650) 232-9612 <br /> Consultant Company �r 4 j a $.� Project Name 3 (_ 13 tj <br /> Address y S' 4 �� S� �� TOSCO Engineer (required) 4u C I <br /> City DL ; - State CA Zip Code S,q5- S33 <br /> Telephone ZS- -55 r- S S FAX # rr Z�-�j-SI- '1,g8E Site #, City, State 4 <br /> Report To �� L� Sampler _ SM h QC Data evel D (Standard) ❑ Level C ❑ Level B ❑ Level A v <br /> - Y <br /> Turnaround U 10 Work Days )&5 Work Days U 3 Work Days U Drinking Water Analyses Requested ac- <br /> Time U 2 Work Days U 1 Work Day U 2-8 Hours U Waste Water �� �tio°, �ti�\ <br /> 41 O``3 411. �P <br /> CODE: U Misc U Detect ❑ Eval U Remed ❑Demol ❑Closure XQther 1h4o oho\ 0 .10 4D <br /> Client Date/Time Matrix # of Cont Sequoia's <br /> `P� <br /> Sample I D Sampled Desc ContType Sample # Comments <br /> 2 w_� \K ?� D <br /> Cr <br /> 3 X x ) <br /> va <br /> 4 Vv Q x o <br /> 5 <br /> 6 <br /> 7 <br /> 8 <br /> 9 <br /> c� <br /> 10 � <br /> Cr <br /> a� <br /> Relinquished By Dated Timet Received By o Date Time 5 a, <br /> / w <br /> Relinquished By ` Date Time 3 Re e�8y T.Y!' n Dao �j< 1 Time 1 z <br /> Relinquished By Date Time Received By Date Time <br /> Were Samples Received in Good Condition? ❑Yes U No Samples on ice? U Yes ❑No Method of Shipment Page_of <br /> r <br /> To be completed upon receipt of report <br /> 1)Were the analyses requested on the Chain of Custody reported? ❑Yes ❑ No It no, what analyses are still needed? <br /> 2)W the report issued within the requested turnaround time? ❑Yes U No If no, what was the turnaround time? <br /> Approve Signature _Company <br />