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•-� t• p_ � City, ) i Q S C-� X680 Chesapeake Drive•Redwood Cit ,CA 941!6M3- 415100 640 U 18939 120th Ave, Sul a Bo e A 9 (20 � } U 819 Striker Ave,Suite 8•Sacramento,CA 95834•(916) U East 14 115 Montgomery, Suite B Spokane,WA 99206•(509 924 !, 1 U 404 N Wiget Bane•Walnut Creek CA 94598•(510)988 9600 {J 15055 S W Sequoia Pkwy,Suite 110•Portland OR 97222•(503)624 9800 �onsultant Company 1 LLG� f ✓ Project Name 3i _ `1 LI I A 4ddress , ) I:1NGHG 4L.Project Manager �� , C �� i ' lv((� 2 -1 7 --7- city _ r dS G State Zip Code 95710 APB # � T) Telephone �{(�{�'• '� -7S �« FAX # Site #, City, State g l 5W�-)—J S IL (/1 U e art To _-b1Y1u Sam ler J (A- 'V OC Data tfLevel D (Standard) ❑ Level C ❑ Level B ❑ Level A C: n Turnaround 10 I�Vork Days ❑ 5 Work Days FJ3 Work Day§ U Drinking Water Anal ses Requested t^ i or er a-"�i2. ii CGc". Time ❑ 2 Work Das J �dork Da i - Flours ILIWaste Water \^��• Q� CODE IJMisc ❑ Detect Id Eval ❑ Remed 1:1Demol IJClosure U`0ther `�� Client Date/Time Matrix tj of Cont Laboratory ��, W Sample I D Sampled Desc Cont Type Sample # Comments 2 13 4 1"' • �� t ' _ L � rn 2 i ZyS w1$r:l4 +k e 0 J VD-3— oc � ,23} o�j92r,uir o TD-4 �) _ LA) Z Svc gr l Relinquished By Date ime Received By �m Fwl;1i Date z Time m Relinquished By Date Time Received B ,�, Date VITime Ll1S Relln uished B � Dat 1 r Gjc Time Received By Lab Date n�Y'�Time ' Z rlsy It z ar s ecelJ d Condit on iJ Yes�J No Samples on ice? IJ Yes U No Method of Shipment Page of'V P eted upon receipt of report ,-,,the analyses requested on the Chain of Custody reported? ❑ Yes IJ No If no, what analyses are still needed? �e leport issued within the requested turnaround time? iJ Yes❑ No If no, what was the turnaround time?-----Signature _____--------Company ____._ Date