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i <br /> 1 ESc c) OK k+V fR Ur8B4 Chesapeake Drive•Redwood City,CA 94063•(415)364-96M U TOM Uft Ave,N E,Suite 101•Bothell,WA QW11+(MB)4814WO <br /> ❑8195SnkerAve SutDO*Sataamem,CA 958.44•(91&)921-StDD ❑ Fist 11115 MwU90mery,SWe 3-Spokane,WA 99M•(509)924_.3M <br /> ❑404 N Wipel l.,ane•Walnut Cheek,CA 9450■(516)988.980D U 151M S,W Sequara Pk%W Suite 110•P rftr d OR 97222•(5031 eM-980D <br /> Lit c I � <br /> ED Consultant Company Protect Name ? �, 7 • r <br /> Addressh l�Pt9l AA!Project Manager , <br /> �� L <br /> City- .: State Zip Code ) AI=E <br /> c <br /> Telephone gi4j —(up FAX N - Site#, City,State BE 6,927 °1 <br /> U <br /> ReportTo z} <br /> R Sam er 'J t i` Co-, C Data Eftevel D(swriard) ❑ Level C ❑ Level B ❑Leve!A c <br /> Yumaround ❑ 1()Work Days 5 Work Days ❑3 Work Days ❑ Dnnking Water AT&x, rte <br /> Time: ❑2 Work Da O 1 Work Da ❑2-8 Hours ❑ Waste Water i PE, ET*4 <br /> CODE:❑ misc ❑Detect Eval ❑Remed ❑ Demol ❑Closure I d0ther <br /> Client Date/Trme Matrix N of Gout <br /> Laboratory <br /> Sample I D Sampled Desc Cont Type Sample♦t ,� 2mmenls <br /> r 1 w 3 'nr Y kqg X 2 <br /> 3 <br /> 4 <br /> Q s } <br /> U s <br /> ., <br /> � 7 <br /> a B <br /> C <br /> �.4 9 <br /> 0 <br /> w 110 <br /> Lr) � o <br /> t <br /> cr <br /> m Relinquished By ti Qate_ 'EnReceived e Vis' r�'-Date f Time ��Relinquished ByDate `Si G� ad B Date Time <br /> m <br /> Relt wished Date Time ReceivedB Lab Dfs) ate ����'b Time i `�qj� <br /> Were Samples Received in Good Condition?O Yes©No Samples an Ice? U Yes lb No Method of Ship Page <br /> aa 9 <br /> To be completedc=pleted upon receipt of report. <br /> 1) Were the analyses requested on the Chain of Custody reported? ©Yes 7 No It no,what analyses are still needed? <br /> 2) Was the report issued withm the requested turnaround time? J Yes❑No If no,what was the tumaround time? <br /> Approved --- Signature---- -- __ —Company �_ _ Data <br />