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U N OSA1 ❑819 Striker Ave,Suite 8•Sacramento,CA 95834 921-9600 0 East 11115 Montgomery,Suite B•Spokane,WA 99206•(5*4-�M <br /> A-9200 <br /> O 404 N Wiget Lane•Walnut Creek,CA 94598•(51 8-9600 0 15055 S W Sequoia Pkwy,Surte 110•Portland,OR 97222•( <br /> Consultant Company Ge r,k%'4� R -- J Project Name e f D <br /> Address O-L4-t S jeyr �pv �-} S-K , J UNOCAL Project Manager rvlr, o <br /> City 'N �' State Zip Code S (3 AFE# .. <br /> c <br /> w <br /> Telephone S - FAX#(22,45s:(- 18qq Site#, City, State q3l E etr 0 U <br /> Re ort To Sam p ler L/ T6tS '(c e) QC Data Level D(Standard) ❑ Level C ❑ Level B ❑ Levet A C <br /> Turnaround l 10 Work Days 5 Work Days ❑ 3 Work Days ❑ Drinking Water jAnalyses Re uested a <br /> Time: ❑ 2 Work Das ❑ 1 Work Day ❑ 2-8 Hours 00 Waste Water <br /> CODE: ❑ Misc ❑ Detect ❑ Eval ❑ Remed ❑ Demol ❑ Closure ❑ Other <br /> Client Date/Time Matrix #of Cont Laboratory <br /> Sample I D Sampled Desc Cont Type Sample# Comments <br /> Z <br /> 1 7;8. LS ►1 g Ld 1 VO4- 01 k/ a <br /> u� � •, 3JSpty -� � � � <br /> 3 ( -• Z z,3B ply 4 3 X <br /> `/ 3 <br /> 4 Ll 3 ,7d�A► 3 1� m <br /> 5 /'ST p�v 4- 3 ti X } <br /> s k T7 11"W�y �- 3 X <br /> 6 k Q1,;2-�,Ay 3 K <br /> z <br /> 10 U. 3 4 (7 K �J <br /> 0 <br /> Relinquished By Date 11 8 Time PlOceived By Date rime <br /> I '= <br /> Relinquished By Date Time Received By Date Time <br /> Relinquished B Date Time Received B Lab Date C��d ime z <br /> Were Samples Received in Good Condition?0 Yes d No Samples on Ice? 0 Yes O No Method of Shipment Page^of <br /> To be completed upon receipt of report <br /> 1) Were the analyses requested on the Chain of Custody reported? 0 Yes 0 No If no, what analyses are still needed? <br /> 2) Was the report issued within the requested turnaround time? 0 Yes❑No If no,what was the turnaround time? <br /> Approved by Signature Company Date <br />