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n'680 Chesapeake Drive•Retfvmod City,CA tRrM4-9W ❑ 189n 1201h Ave,N E,Swle 101 •Bothell,WA 96011 •{ 1-9200 <br /> ` �; ` :J 819 SrriherAve,SulteB•Sacraments}CA 958 1 21-9000 0 East 11115 Montgomery,So,te B■Spokane,WA 99206•{ 4-5200 v <br /> U > L <br /> J 404 N target t.arre•Walnut Creels,CA 94598•(510)956600 ❑ 15455 S W �uatia Pkwy Sum 110•Portland,OR 9222■{503)624 5800 . <br /> r <br /> Ndd <br /> mpany /�r, r J�, � _}% rte S Protect Name r; l' 7 7, <br /> UNOCAL Project Manager <br /> s r���'c:'-�Cd 'r State Zip Code ' f AFE# $3` �l Z/pd 4 3 �o <br /> f :'6 FAX# , J / 3 Sete ,City,state <br /> a U <br /> Tor t'r (I Y� Sam ler 't QC Data �evei D(standard) ❑ Level C 0 Level B ❑ Level A <br /> TKWork Days ❑ 5 Work Days ❑ 3 Work Days ❑ Drinking Water ikoa1 ses Ra uested <br /> ❑2 Work Das ❑ i Work Day ❑ 2-8 Hours Q Waste Water Y77 <br /> 1711 <br /> CODE:ChMisc Q Detect Lk Eva, 0 RemDed ❑Demoi C] Closure Other � � � 6q 3 <br /> Client DatelTime Matrix #of Cant laboratory <br /> Sarnple I D Sampled Desc Cont Type Sample# � � Comments <br /> f)r f i <br /> 4 <br /> 5 <br /> J <br /> 9 <br /> td ( 6 <br /> O <br /> Relinquished B - - Datef— Time eG Received By Date Time <br /> w <br /> Relinquished By Date Time Received By Date Time 3: <br /> �f <br /> ate e zS Time_ '_� <br /> Ruin »fished B Date. Time Received B Lab <br /> Were Samples Received in Good Condition es 0�+lo Samples on Ice? Q Yes Q `�+lethad of Shipment Page-.of <br /> EAppreoved <br /> mplete upon receipt of report <br /> FWere the analyses requested on the Chain of Custody reported? 4YesuNo It n,o,what analyses are stili needed? <br /> Was the re sued within the requested turnaround time? � �=Mpany <br /> e turnaround t1 ? <br /> byr J 2� / '�Signature — 5� _Date. <br /> i <br />