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-U-61111 Chesapeake Drive•Redwood City,CA 940 15)364-9800 ❑ 18939 120th Ave,N E,Suite 101 •Bothell,WA 98011 •(2 81-9200 <br /> 1J{ ❑ 819 Striker Ave,Suite 8•Sacramento,CA 95 (916)921-9600 ❑ East 11115 Montgomery,Suite B•Spokane,WA 99206•(024 9200 y <br /> A L ❑ 1900 Bates Ave,Suite LM•Concord,CA 94520•(510)686-9600 ❑ 15055 S W Sequo2a Pkwy,Suite 110•Portland,OR 97222•(503)624-9800 ' <br /> Company Name , Project Name ` All <br /> Address �' r I / ;/G UNOCAL Project Manager <br /> City ���� ?f�j , �, r)c State �'� Zip Code Release# <br /> Telephone rf �- % >' �r1 FAX# J f — 1111/1 Site# <br /> Re ort To (�r <br /> V-t`J r f Sam ler �'` QC Data -Q-LeVel D (Standard) ❑ Level C ❑ Level B ❑ Level A <br /> ii <br /> Turnaroun 10 Work Days ❑ 5 Work Days 1:13 Work DaysL) Drinking Water [Analyses Requested <br /> Time ❑ Work Das ❑ 1 Work Day ❑ 2-8 Hours ❑ Waste Water <br /> CODE ❑ Misc ❑ Detect ❑ Eval ❑ Remed C) Demol ❑ Closure ❑ Other 1� ' tC <br /> Client Datefftme Matrix #of Cont Laboratory <br /> Sample I D Sampled Desc Cont Type Sample# Comments <br /> �y 14 4-1 <br /> 0 <br /> 2 O <br /> • J J <br /> 3 <br /> 4 <br /> m <br /> 5 <br /> 6 <br /> 7 <br /> 8 <br /> 9 <br /> 0 <br /> 10 <br /> 0 <br /> Relinquished By Date ' { lme lJ C Received By Date Time <br /> Relinquished By Date Time Received By_ Date r Time <br /> Relinquished B Date Time Received B Lab �`� � Date I 71 - Time <br /> Were Samples Received in Good Condition?-Yes a No Samples on Ice9 ❑Yes4aN o Method of Shipment Page L of L <br /> To be completed upon receipt of report <br /> 1) Were the analyses requested on the Chain of Custody reported? ❑Yes❑ No If no,what analyses are still needed? <br /> 2) Was the report issued within the requested turnaround time? U Yes©No If no,what was the turnaround time? <br /> Approved by Signature Company Date <br />