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LJI ❑18939 120th Ave,N E Suite 101 •Bothell,WA 98011 •(206)481-9200 <br /> AL a 680 Chesapeake Drive•Redwood Cdy,CA 94063!(650)364-9600 WA 99206•(509)924.9200 <br /> UNOC L)819 Sinker Ave,Suite 8•Sacramento,,CA 95834.1(916)921-9600 ❑East 11115 Montgomery,Suite B•Spokane, <br /> 1 15055 S W Sequoia Pkwy,Suite 110•Portland,OR 97222•(503)624 9800 <br /> O 404 N Wigel Lane•Walnut Creek,CA 94598•(925)988-9600 <br /> O 1455 McDowell Blvd North,Suite D•Petaluma,CA 94954•(707)792-1865 <br /> Consultant Company &ep /� c Inc,, A 1 - goo`F I Project Name r,),v) -e G/hv�•e• l sS W <br /> Address (0:7 UNOCAL Project Manager Hr. �L �:�Ce1 <br /> City ,b c. �c b State Com. Zip Code YDS S AFB # J J7Y <br /> FAX # ,T Site City, MrNCr c.kAz <br /> � <br /> Telephon�qi� SS <br /> L) <br /> QC Data Level D (Standard) ❑ Level C O Level B ❑ Level A <br /> Report To ,beanoz . Sampler f � 7 i IC:�- c <br /> Turnaround *10 Work Days ❑5 Work Days ❑3 Worki Days ❑Drinking Water <br /> Analyses Requested fl, <br /> Time: ❑ 2 Work Days ❑1 Work Day ❑2-8 Route T Waste Water p <br /> ❑Other �Q <br /> CODE; ❑Misc ❑Detect ❑Eval ❑Remed ©Demol � ❑Closure <br /> Client Date/Time Matrix #of Cont Laboratory <br /> Comments <br /> Sample I D Sampled Desc Cont Typei ,§ample# 4 z <br /> &41 f( <br /> 0 <br /> 2 U - I <br /> 3 u - <br /> 4 U - <br /> 5 u L% ti k <br /> s <br /> 7 tA- <br /> 8 U' 4 t o <br /> is/ sr �� jc�J - � <br /> 9 (A o <br /> 10 LA <br /> t Date X10 Time `�� Received By (7L Date Time i d <br /> Relinquished By Z <br /> Date Time <br /> Relinquished By -;� Dat , , Time , )5 Received By <br /> ReGn wished B Date Time Received By Lab �,,..� Date Z v Time <br /> q y <br /> Were Samples Received in Good Condition? ❑Yes ❑No Samples on Ice? ❑Yes ❑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? ❑Yes ❑No ' If no,what analyses are still needed? <br /> 2)W report Issued within the requested turnaround time? O Yes No If no, what was the turnaround time? <br /> � v <br /> Approved by Signature Company <br /> D <br />