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❑680 Chesapeake Dave•Redwood City,CA 94063•(650)364 ❑16939 120th Ave, N E Suite 101 •Bothell,WA 98011 •(206)4 0 <br /> �No AL <br /> ❑819 Striker Ave Suite 8•Sacramento,CA 95834•(916)921-9600 ❑East 11115 Montgomery,Suite B•Spokane,WA 99206•(509) 206 <br /> . 0 <br /> ❑404 N Wiget Lane•Walnut Creek,CA 94598•(925)988-9600 ❑15055 S W Sequoia Pkwy,Suite 110•Portland,OR 97222•(503)624-9800 <br /> ❑ 1455 McDowell Blvd North,Suite D•Petaluma,CA 94954•(707)792-1865 <br /> Consultant Company G�tP�r-i` a.o, Tr,e Je) # Z$OD 4-4-.?3 i Protect Name dCbrM er SE.6& <br /> Address 6qq s7arfCA co""4 S•�, � UNOCAL Project Manager Nr <br /> City CbU �I(44 State (=,qZtp Code Q t/�'6$ AFE # <br /> C <br /> Telepho a qLs� Ste_ FAX # q S-4-7g� Site #, City, State 103�4 G <br /> Report To h �, 4/ '` Sampler V 75-KOC Data Level D (Standard) IDLevel C ElLeve B © Level A <br /> Y <br /> Turnaround 10 Work Days 5 Work Days CI3 Work Days EllDrinking Water Analyses Requested a <br /> Time ❑ 2 Work Days ❑ 1 Work Day ❑2-8 Hours Waste Water <br /> CODE: ❑ Misc ❑Detect ❑ Eval ❑Remed ❑ Demol ❑Closure ❑Other \(9 <br /> Client Date/Time Matrix # of Cont Laboratory p �� Comments <br /> Sample I D Sampled Desc Cont Type Sample # U� <br /> v) r .� Q <br /> 1,t33 Jw a t C7 t vO A r>P{>f S 0 <br /> 2 U � <br /> 1 1 �zv ti � s� �r �L.. � x !✓ �� � <br /> 03 <br /> --[4 3v 11 c,r '� U� <br /> `I 11y, r <br /> 5 u� � <br /> 6 u - s Z."' L+ U b ?C <br /> 7 rP Ik. 6 41 0-7 X <br /> a . -I- I°`' `5 a ' C x x z <br /> 9 <br /> 10 , <br /> Date Time Received By Date , u p Time 163 <br /> Relinquished By ,3 U O <br /> Relinquished By Date Time Received By Date Time <br /> Relinquished By Date Time Received By Lab 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? O Yes ❑ No 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 />