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U 680 Chesapeake tanve•Redwood City,CA 94015)364 9600 u 18939 120th Ave,N Suite a tis I <br /> CAL C1819 Striker Ave,Suite 8•Sacramento,CA 958*16)921 9600 U East 11115 Montgomery,Suite B Spokane, <br /> WA 99206•( 24 9200 � r <br /> UND ❑ 404 N Wiget lane•Walnut Creek,CA 94598•(510)988 9600 ❑ 15055 S W Sequoia Pkwy,Suite 110•Portland,OR 97222•(503)624 9800 <br /> Protect Name /0-;> <br /> Consultant CompanyC- <br /> Address `� S'/Prna Sr UNOCAL Protect Manager <br /> City cJ� h State Com. Ztp Code q YJ-6 AFt= # <br /> FAX# Site #, City, State 61 L3 , r' r <br /> ' U <br /> Telephone CT FAX' ` <br /> Report To Sampler <br /> ala ,�ps 7� •/4'y QC Data ❑ Level D (Standar el C ❑ Level B ❑ Level A <br /> Turnaround 10 Work Da 5 Work Days ❑ 3 Work Days ❑ Dunking Water ( `LW wwwes Requested <br /> T1me ❑ 2 Work Das ❑ 1 Work Day ❑ 2-8 Hours Waste Water <br /> v <br /> CODE: ❑ MISC ❑ Detect ❑ Eval ❑ Homed 13Demoi ❑ Closure ❑ Other <br /> Client Date/Time Matrix # of Cant Laboratory �� Q� Comments <br /> Sample I D Sampled Desc Cont Type Sample # <br /> �/ f 'f $ ''�2 1� ��, 51�1� cpo <br /> 2 <br /> U Z r -1 <br /> 3 ttom K �1iti to <br /> r 4 3 1%�6 <br /> Y <br /> 5 <br /> 6 Gds Gtrt -If, , <br /> 7 � <br /> 8 <br /> 9 <br /> 10 tu <br /> Time Us—/►c- Received B r I - Date ` ifs tme, <br /> Relinquished By Date _3A a <br /> 7S r 1. Date Time /(�•p <br /> 1.//' <br /> ( Date !: Imer`�= Received B � <br /> Relinquished By < <br /> Received S Lab r l( dU1 Dale tme �,� <br /> Rehn wished Bv Date <br /> Samples on Ice? 0 Yes 0 No Method of Shipment <br /> Were Samples Received in Good Condition? Yes 0 No Page_of_ <br /> To be completed upon receipt of report _ -- -- <br /> 1) Were the analyses requested on the Chain of Custody reported? 0 Yes U No If no, what analyses are still needed? <br /> N 2) Was the report issued within the requested turnaround time? ❑Yes 0 No If no, what was the turnaround time? Date <br /> ��d by <br /> Signature �_ _ _ __ _-------Company �__ <br />