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roS C 0 fnt,1 %a 680 Chesapeake gave•Redwood City,CA 94063•(415)364-9600 O 19939 1201h Ave,N E,Sude 101•Bothell,WA 38011-(206)481 9200 <br /> Q 819 Stroke r Ave,Sude 0-Sacramenla,CA 95834•(916)921-9800 O East 11115 Montgomery,Suite 8•Spokane,WA 99208•(509)924 9200or ' <br /> ❑ 404 N Wrget Lane•Walnut Creek,CA 94599. 5t0 988.9500 ❑ 1W65 5 W S •Portland OR 97222• <br /> ( ) Sequoia Pkwy.Sude 110 (500)5249800 r y <br /> 56 `� <br /> Consultant Company Protect Name 1 _17 , r <br /> AddressML 04 4 8 6N�i9F,At Pro)ect ManagerCID <br /> !0 21 -_3357 <br /> City e,,, Slate Zip Code 115t I n AFE N <br /> Tele hone C - 1 - 715 0 FAX �75 341 Sete N,Cl ,State P A 4 C7 <br /> Report To Sam ler �,4 AkIligiao QC Data ULevet D(Slandard) O Level C ❑Level B ❑Level A c <br /> Turnaround <br /> iftlork Days ❑ 5 Work Days Q 3 Work QaYs U Drinking Water )Analyses Re uesled <br /> Time. Q 2 Work Das Er1 Work Day ❑2-8 Hours ❑ Waste Water <br /> CODE: ❑Mrsc Q Detect O Eval 0 Reined U Demol U Closure 2Other <br /> Client DatefTime Matrix #of Cant Laboratory Q�� Q� <br /> Sample I D Sampled Desc Cont Type Sample If /. f+ , �`'� Comments <br /> 0 <br /> .. <br /> 2 — m <br /> ' c .n° <br /> s <br /> 4 Gri_13 Shr~ ow n Lr a <br /> 612 -A <br /> 1 <br /> 6 a Ta' <br /> AP lOd �6Lb <br /> )o n 5-11 LU <br /> 10 o <br /> �a <br /> L <br /> a <br /> .a <br /> Relinquished By Date Trine Received B Date Q� Time / t3 <br /> i <br /> Relinquished By DateTime 131'fs 11, <br /> eceived B Date TimeRetro uished BMegme eceived By Lab Date_2#0F ime r 3 <br /> Were Samples Received in Good Condition?❑Yes l3 No Samples on Ice? 0 Yes U No Method of Ship It Page_of <br /> a be completed upon receipt of report <br /> 1) Were the analyses requested on the Chain of Custody reported? Q Yes O No If no,what analyses are still needed? <br /> 2, Was the report rasped wrthm the requested turnaround fimel' ®Yes❑No If no,what was the turnaround tune? _ -- <br /> Approved by Signature Company Date <br />