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78'19 <br /> Chesapeake Dmre•Redwood City,CA 415)364-9600 U 18939 120th Ave,N E,Sude 101 •Bothell,WA 98011 •(206)481-9200 <br /> Stnker Ave,Suite 8•Sacramento,CA 9A <br /> (916)921-9600 ❑ East 11115 Montgomery,Suite B•Spokane,WA 99206•*4-9200 <br /> UN AL 19 <br /> ❑ 1900 Bates Ave,Suite L.M•Concord,CA 94520•(510)686-9600 ❑ 15055 S W Sequoia Pkwy,Susie 110•Portland,QR 97222•(503)624-9800 <br /> Grob IQ 6 <br /> Protect Name Fp�►�C (�g `r— <br /> ompany Name dye No, a f 7 <br /> Address r. e 17Q UNOCAL Protect Manager A 1 <br /> City h State A Zip Code 9 6 7 Release# <br /> Ot <br /> Telephone 6 631 - 1300 LD <br /> FAX# 6 t--1 i 7 Site# 0 1 3! F r �IV,°1r �fOt1 DN U <br /> c <br /> Re ortTo V t L ISampler �jafrey i+�f r rflQC Data 16 Level D(Standard) Level C ❑ Level B ❑ Level A Jc <br /> a <br /> Turnaround Ik 10 Work Days ❑ 5 Work Days ❑ 3 Work Days ❑ Drinking Water 0A Ana! ses Re uested <br /> Time: ❑ 2 Work Das ❑ 1 Work Day ❑ 2-8 Hours ❑ Waste Water <br /> CODE: ❑ Misc ❑ Detect ❑ Eval ❑ Remed ❑ Demol ❑ Closure ❑ Other <br /> Client Date/Time Matrix #of Cont Laboratory Comments <br /> Sample i Q p Desc Cont Type Sample# <br /> 1 <br /> L/ - 3 `3 V� A- ` <br /> 0 <br /> 2 P � — b « 4r <br /> 0 <br /> 4 <br /> 5 <br /> -- z- 6 6 1 of <br /> 7 U 0 �q <br /> 9 o <br /> 10 `0 <br /> w <br /> Relinquished By Date y f9 Time Received Date rime J <br /> m <br /> Relinquished By Date Time Received B <br /> Date Time <br /> Relinquished By Date ITime Received By Lab Date Time <br /> Were Samples Received In Good Condition?❑Yes❑No Samples on Ice? ❑Yes a No Method of Shipment rage of_ <br /> FApproved <br /> eted upon receipt of report <br /> the analyses requested on the Chain of Custody reported? ❑Yes U No If no,what analyses are still needed? <br /> the report issued within the requested turnaround time? ❑Yes❑No If no,what was the turnaround time? Date <br /> Signature Company <br />