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µ ❑ 680 Chesapeake Drive•Redwood City,CA 94063•(41,11314-1100 ❑ 18939 120th Ave,N E,Suite 101 *1 otholl,WA 98011 •(206)481-9200 <br /> —^ U N O C A L ❑ 819 Stnker Ave,Suite 8-Sacramento,CA 95834•(916)921-9600 ❑ East 11115 Montgomery,Suite B•Spokane,WA 99206-(509)924-9200 <br /> 0 1900 Bates Ave,Suite LM•Concord,CA 94520•(510)686-9600 Q 15055 S W Sequoia Pkwy,Suite 110•Portland,OR 97222•(503)624-9800 <br /> Company Name S Project Name ��r t, <br /> Address "�} -i ���`� Q--4 �� �]<< :� �� UNOCAL Project Manager Q <br /> City _ , �'�� ` ,, v �„�.,State Iz—r Zip Code '-T Release# <br /> Telephone 0 FAX Site# ;Y �t } I <br /> U <br /> Report To r� f �� ._ �,!d iSampler ),�J ty - OC Data YLevel D (Standard) ❑ Level C ❑ Level B ❑ Level A C_ <br /> Turnaround ❑ 10 Work Das ❑ 5 Work Das ❑ 3 Work Da <br /> Y Y Ys ❑ Drinking Water [—Analyses Requested <br /> Time ❑ 2 Work Das ❑ 1 Work Day ❑ 2-8 Hours ❑ Waste Water <br /> CODE: ❑ Misc ❑ Detect ❑ Bval ❑ Remed ❑ Demol ❑ Closure ❑ Other `` v <br /> Client Date/Time Matrix #of Cont Laboratory <br /> Sample I D Sampled Desc Cont Type Sample# Comments <br /> -� <br /> 2 ^�'C� 1_w, 1=A71°�j3' tot s: 1U� <br /> 3 " co <br /> 4 <br /> 0 <br /> 5 <br /> 6 <br /> 7 <br /> a � <br /> 9 <br /> 14 0 <br /> co <br /> l 1r <br /> O 3 <br /> Relinquished By ,j?-�-�`w i� DateTime le% C Received B -moi �W` �� Date , <br /> //50` Time J <br /> Relinquished By r --y"' Dater ` Time Received By Date Time <br /> Relinquished By I Date ITime I Received By Lab J �� / f Date'� �4 �' Time <br /> Were Samples Received in Good Condition?0 Yes❑No Samples on Ice? a Yes ❑ No Method of Shipment Page_of_ <br /> Y To be completed upon receipt of report <br /> d 1) Were the analyses requested on the Chain of Custody reported? U Yes 0 No If no, what analyses are still needed? <br /> 2) W report issued within the requested turnaround time? L3 Yes O no,what was the turnaround time? <br /> Approved by Signature Company _ <br /> Date <br />