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NMI <br /> Q s C o 680 Chesapeake Drive•Redwood City,CA 94063•(415 600 189 ih APIR,,Sul e •Bo ie A •(20 i <br /> f U 819 Sinker Ave,Suite 8 Sacramento GA 95$34 916 921 9600 U East 11115 Montgomery,Suite B•Spokane,WA 99206• 509)924 0 <br /> I <br /> U 404 N Wiget Lane•Walnut Creek CA 94598•(510)988 9600 IJ 15055 S W Sequoia Pkwy Suite 110•Portland OR 97222•(503)624 9800 <br /> �onsultant Company ! LLL' V C Project Name 31 _1 I LI 1 <br /> Address , ) WNeGflL Project Managerll� ' ( cw i { ' S 1 d 2-7 7 -Z <br /> City r dS G State � Zip Code �S 1 f AFE #t <br /> c <br /> Telephone qog• ' f-7S Q(_5 FAX # 5 3C Site #, City, State a ptt Sy,-1-1 <br /> Report To _-bi-nuzz,f2 ISampler v QC Data TLevel D (standard) ❑ Level C IJ Level B ❑ Level A C <br />'Turnaround E P'O' Vork Days ❑ 5 Work Days ❑ 3 Work DayO 1:1Drinking Water Analses Requested I <br /> Time ❑ 2Work Das �drWoir'k Da'Z r-Ild- 5urs t- <br /> � Waste Water <br /> i CODE ❑ Misc ❑ Detect ld Eval ❑ Remed ❑ Demol FJ Closure 13—Other <br /> Client Date/Time Matrix # of Cont Laboratory <br /> Sample I D Sampled Desc Cont Type Sample # Comments <br /> 1113 q 1' ta •r l i i F <br /> 2 IZ�5 wl cza +he <br />'d _HED 123 atyg�rut�r' 0 <br /> a� <br /> -q 2- 3)G I <br /> 8' <br /> 7 7'b <br /> -1 <br /> f'e' z <br /> o PP 3 0 <br /> Ir <br /> 4 <br /> Relinquished By �-- Date ime 3� Received B ' n' fi,ilDate Time <br /> R"nu <br /> lhd By Date Time Received B 41 Date;�17 �r p Time <br /> 4i� ,� l5. Dat r/l�tTime Fleceived B LabDate 0/ 411f Time U� <br /> ceided t o�cl'�'ondtt on i�Yes U No Samples on Ice? ❑Yes U No Method of Shipment Page of <br /> �p eted upon receipt ol report <br /> �ethe analyses requested on the Chain of Custody reported? U Yes 1-1 No if no, what analyses are still needed? <br /> �e report issued within the requested turnaround time? U Yes❑ No If no, what was the turnaround time? <br /> Signature _ Company ___ Date <br />