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14" �1✓ - -- - - !• t• SII Q 819 Striker Ave Suite 8•Sacramento CA 85834•(911 9600 U East 11115 MontgomerySuite B•Spokane 206• 2 UNoA- L - Q 404 N Wget Lane•Walnut Creek,CA 94598•(510)98 600 U 15055 5 W Sequoia Pkwy)Sade 110•Portland,OR 87222•(503) 00 Project Name ``511- 1741 di Consultant Company r�, � , , , I �_ i E l , UNOCAL Project Manager ,` < Address s ;1 , , , +� t 1 City �,I )r I State f Zip Code i`. I I ( � AFB # Site #I City, State v FAX # ! , j ''� . , Telephone I i k Report To _ i r_ .�, t. I f` '",�+ -1i, t t Sampler ) t`1, l I `, L7 t QC Data CJ Level D (Standard) FJ Level C ❑ Level B ❑ Level A c Turnaround ❑ 14 Work Days © 5 Work Days Q 3 Work Days 1] Drinking WaterRhairses Re nested Time Q 2 Work Das 0 1 Work Day Q 2-8 Hours ❑Waste Water CODE. Q Misc ❑ Detect ❑ Bval ❑ Remed ❑ Demol Q Closure Q Other Cont Laborato r �` `� Client Daterrime Matrix # of ry 2 j �� Comments r`4 Sample I D Sampled Desc Cont Type Sample# t L o LJ i + lr } 5 6 II i y s, X11 I 8 tilt 11 i' t` .I 1� i<1 I 111 JI 4)" 110 I � I J f , t5" -C-��,-. Date -' T r Time Relinquished By 1 " /1%� Date /' Time Received B - - _ _ - _ _ 1 , �•'rr i Y r�__ Received B - - - Date Time Relinquished By Date T+tom-= - Relinquished t3 �`' ~ w Date Time Received By Lab/ `1i / Date ` i f Time ' Were Samples Received in Good Condition? ❑Yes C) No Samples on Ice? ❑Yes❑ No Method of Shipm�nt Page of Tobe completed upon receipt o report _ 1) Were the analyses requested on the requestedCahn of Custody time?reportep Yes Q No Yes U Ij no, what was the no, what lturnaround yses are i1time? needed? - 2) Was the report issuedDate T %proved by _ �___ ----Signature - — Company �_ - ----