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'� I} j u 680 Chesapeake Drive•Redwood City,CA 94063•(650)364- 0 18939 120th Ave,N E Suite 101 •Bothell,WA 98011�(206)481-9200 <br /> ❑819 Striker Ave,Suite 8•Sacramento,CA 95834•(916)921- O East 11115 Montgomery,Suite B•Spokane WA 9920•(509200 <br /> t �' _ rl, 0 404 N Wiget Lane•Walnut Creek,CA 94598•(925)988-9600 015055 S W Sequoia Pkwy, Suite 110•Portland,OR 9,7222•(5 624-9800 <br /> 0 1455 McDowell Blvd North,Suite D•Petaluma,CA 94954•(707)792-1865 # <br /> 1fa1 'tnpany sr. Ay Q" li+& . X).4Z8`=Vr Protect Nam6F�r� r I <br /> P 4 <br /> =" q ���rr� �� s„�f>�c�c7r� UNOCAL Pr tett Manager Mr N';c.L "� r <br /> !tv ;I State C4 , Zip Code AFIt # <br /> FAX # ��-/� �'pg� Site #, City, tate yX.?.Ea�fi 1�►�fi r ,� I m <br /> To Sampler V �c S OC Data Level D (Standard) 0 Leve! C El Level B F 0 Level A Y <br /> u uni114 0 Work Days 0 5 Work Days O 3 Work Days 0 Drinking Water Analyses Requested d- <br /> i # 2 Work Days 0 1 Work Day ❑2-8 Hours Waste Water <br /> ❑Other <br /> isc ❑ Detect O Eval 0 Remed 13 Demo! ❑Closure <br /> E C i Date�me Matrix # of Cont Laboratory p`tC Comments <br /> pn I ,D Sampled Desc Cont Type Sample # <br /> O <br /> SY a o <br /> 'f ti <br /> 51- K S" <br /> s <br /> Lw x <br /> l •r I <br /> } <br /> O <br /> inq s ` d By Date 0 Time S M Recetved�By Date s a Ttme <br /> �q $ } d By Date ime/G.�Jb Recety , By Date Time <br /> I <br /> snq 41! d By Date Time e e Date p� Time <br /> mp 4eceived in Good Condition? ©Yes ❑ No Samples on Ice? 0 Yes 0 Noi Method of Shipment Page of <br /> 1 b ori <br /> } d upon receipt of report ' <br /> W " e analyses requested on the Chale of Custody reported? ❑Yes ❑ No If no, what analyses are stili needed? <br /> tl] f W ip, a report Issued within the requested turnaround time? ❑Yes ❑ No If no, what was the turnaround time? <br /> ted �" Signature ompany G-A i� . i Date 1/1SAJ <br /> h <br />