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COMW680IMpeaRM-RMWd Cit406 )36M lM939 IMve,wileMl-Bolher" 980 0 �m0 <br /> U -L Ur U 819 Striker Ave,Suite 8-Sacramento,7CA834 )921 9600 U East 11115 Montgomery,Suite B-Spokane,WA 99206-(5t�4 9200 <br /> U 404 N W+gel Lane•Walnut Creek CA 94598-(510)988 9600 U 15055 S W Sequoia Pkwy Suite 110-Portland OR 97222-(503)624 9800 <br /> t,r 5 a 5fi <br /> Consultant Company PC,C , ` Project Name <br /> 11 -17q , r <br /> Address , L H O UN6eAL Project Manager , Z 7 7 1335 <br /> City State CpZip CodeCp- AFE It <br /> C <br /> a� <br /> Telephone - - 75 CSD FAX # '"75 3 Site #, City, State 8 P± rt L r _ C v <br /> Re ori To c '4/lr`< <- ISampler �/ r //I Ct Gf QC Data fn Level D (Standard) Li Level C ❑ Level B I] Level A <br /> Turnaround 4 s ❑ 5 Work Das ❑ 3 Work DaYs0CL <br /> U Drinking Water [Analyses Requested <br /> Time ❑ 2 Work Das 11 Work Da J 2-8 Hours IJ Waste Water <br /> CODE: ❑ M1sc ❑ Detect 11Eval U Remed ❑ Demo! IJ Closure F�Olher �' <br /> Client Date/Time Matrix It of Cont Laboratory <br /> Sample I D Sampled Desc Cont Type Sample It /.� V �"E Comments <br /> 2 � � 3t � � � ro <br /> s <br /> 4 !j -13 5 51'"A(u �o <br /> t <br /> 3.-rb - <br /> s -3 <br /> 8 •'e t Iea(J %,.5c pri � <br /> a <br /> 10 <br /> 0 <br /> ctr <br /> 0 <br /> Relinquished By ' ' - Date fAhk Time " • �5� Received By _ %-� Date Time / ' 3 <br /> Relinquished By r! cG r -- Date �f,� fS Tlme Received By Date Time _E <br /> Relincluished By Time I Received By Lab Date�? (Y�_Time 13 `�G <br /> Were Samples Received in Good Condition?U Yes IJ No Samptes on Ice? U Yes U No Method of Ship Ie tt U Paye —of W <br /> To be completed upon receipt of report <br /> 1) Were the analyses requested on the Chain of Custody reported? U Yes Q No If no, what analyses are still needed? <br /> 2) Was the report issued within the requested turnaround time? t,d Yes IJ No If no, what was the turnaround time? <br /> ,ed by __ _- _--- Signature _ �_�_ _Company -- _ - w_--- _-__ --- Date ___ _— <br />