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=W680� ea � )36AW �39 1 � � � - <br /> ( p •R Cit 40fi ve ude olhe 980 0 <br /> U 819 Striker Ave,Suite 8-Sacramento CA 95834: )921-9600 U East 11115 Montgomery,Suite B•Spokane,WA 99206•(50,,24 9200 <br /> V <br /> U 404 N Wiget Lane•Walnut Creek CA 94598-(510)986 9600 U 15055 S W Sequoia Pkwy Suite 110•Podtand OR 97222•(503)624 9800 <br /> f. - <br /> Consultant Company 'Cts Project Name 311 -17 "1 ( <br /> 4 1 <br /> Address -- 1 i 44UNSEAL Project Manager ; , !i1 J 17 7 -13iS <br /> City State CI Zip Code 5,i5ll AFE # <br /> C <br /> Telephone FAX # -75 Site #, City, Stale p -0SLILI _ CA <br /> U <br /> Re art To : ISampler /Q(t�f 1 // 6l QC Data dlevef D (standard) ❑ Level C IJ Level B IJ Level A <br /> Turnaround0 ork Das IJ 5 Work Das lJ 3 Work Da� Y Y Ys ❑ Drinking Water JAnalyses Re nested <br /> Time U 2 Work D1 Work Day ❑ 2-8 Flours L-A Waste Water � �0 <br /> ti <br /> CODE. IJ Misc fJ Detect IdEvaf IJ Remed IJ Demol IJ Closure r�Other ,�,1 �` 4�`��� <br /> Client Date/Time Matrix # of Cont Laboratory <br /> Sample t D Sampled Dese Cont Type Sample # /� y� 1y� Comments <br /> T <br /> 2 <br /> 3 <br /> i� x t,I <br /> V .n e I � <br /> \ 4 cin - 3 acor ,.,it Lr o <br /> r <br /> r <br /> s 3 `' 6L 1 <br /> 10A TAT SL,Q <br /> S t F lead <br /> 1'91 GT3 <br /> a <br /> 10 0 <br /> L <br /> 0 <br /> Relinquished By c- - ' ' Date y Time ` • WSJ Received B / 3 J <br /> Date J" yJ Time J <br /> _ T <br /> Relinquished By �� L Date s is Time 13)"f_ Received B Date Time _E <br /> Relinquished BV Bale Time 1 Received BV Lab I Date _2 0Y�:Tlrne r 3 � G <br /> Were Samples Received in Good Condition?U Yes U No Samples on Ice? U Yes U No Method of Ship(le t- Page —of _ <br /> To be completed upon receipt of report <br /> 1) Were the analyses requested on the Chain of Custody reported? 1J Yes U No If no, what analyses are still needed? <br /> 2) Was the report issued within the requested turnaround time? 1J Yes 1=1 No If no, what was the turnaround time? <br /> ,ed by _m� �_ -- -- _ -- _ Signature -- - - - -__ Company _ _ __-- __ _ Dale <br />