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' you"aaaN�axeunve•Fi ""''",UA 'b4UW•(415)3b49bOO u 18939 120th Ave.N E,Suite 101 •Bothell,WA 98011 •(206)481-9200 <br /> UN(WA L , U 819 Sinker Ave,Suite 8•Sacramento,CA 9 (916)921-9600 ❑ East 11115 Montgomery,Suite B•Spokane,WA 99206 0 9249200 + <br /> U 1900 Bates Ave,Suite LM-Concord,CA 9452 510)686 9600 ❑ 15055 S W Sequoia Pkwy,Suite 110•Portland,OR 97222•(503)624 9800 <br /> Company Name-62 pe2s Project Name ( �'2_ . �Lf <br /> ------------ <br /> Address 3o,5 ®{'OS L- �, [�} UNOCAL Project Manager <br /> City �aVv— State Zip Code gf,%TO Release# <br /> Telephone 6-6 FAX# 631,1. 17- Site # 01%h CA °' <br /> v <br /> Re ort To c✓. C b.T iSampler S ��pt-f— QC Data ❑ Level D (Standard) ❑ Level C ❑ Level B ❑ Level A Y <br /> c <br /> Turnaround ❑ 10 Work Days 1105 Work Days ❑ 3 Work Days ❑ Drinking Water [Analyses Requested <br /> Time ❑ 2 Work Das ❑ 1 Work Day ❑ 2-8 Hours ❑ Waste Water <br /> CODE- ❑ Misc ❑ Detect ❑ Eval ❑ Remed ❑ Demol ❑ Closure ❑ Other Q? <br /> Client Date/Time Matrix #of Cont Laboratory �c <br /> Sample I D Sampled Desc Cont Type Sample# !` Comments <br /> 1 4A/- 10 !9 45- 17"S3 Sot l y o <br /> q 15 <br /> 2 1 0 <br /> uN -Lf - 13.0 <br /> 3 U IV -6fb -t3'!3 yo i l to <br /> 4 - 1S" fill rs -ft?:o9 3 <br /> o <br /> 6 udtjo It'd <br /> 7 U -- Z5 V,q qs- S:q5S <br /> 8 <br /> 9 U ` -L�t� _q : Ob F I` <br /> 00 tA4 - 1019 5- !S 13 JJ <br /> 0 <br /> i� <br /> 0 <br /> Relinquished By Date Time : Received B Date?Z( Time <br /> Relinquished 6 Date Z! —Time Received By// Date Time <br /> Relinquished B Date ITime I Received By Lab Date 7/545Time la(5- <br /> Were Samples Received in Good Condition? Yes❑ No Samples on Ices Yes O No Method of Shi entsed 6(0'104 Page. of J� <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) Was the report issued within the requested turnaround time? ❑Yes❑ No If no, what was the turnaround time? <br /> Approved by Signature Company Date <br />