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4• ��v �� rti��cu c ncurvuuu�,��y �,r� ywvo�•lwintmowao�� a IdVotl itUlnAve,Nt butte 1U1 •Bothell, VVA 96011 •(20b)481-vzU0 <br /> U N CWA L06 924-9200 <br /> f <br /> ❑ 1900 Bates Ave,Suite LM•Concord,CA 9452210)686-9600 ❑ 15055 S W Sequoia Pkwy,Suite 110•Portland,OR 97222. 903)624-9800 <br /> Company Name G4M es Project Name q sz+ 0 I <br /> Address �S e�.t pawtG �, (�a UNOCAL Project Managerb <br /> City Rilm •,d State CA Zip Code 'Tsb 3-O Release# <br /> Telephone FAX# 6 ( — { { Site # 4(q Sfcrr-�c. v <br /> Re ort To S , C0.r�tA Sampler QC Data U Level D (Standard) ❑ Level C ❑ Level B ❑ Level A = <br /> Turnaround ❑ 1p Work Das 5 Work Das ❑ 3 Work Das rl <br /> Y Y Y ❑ Drinking Water ]Analyses Requested <br /> Time ❑ 2 Work Das 1 Work Da ❑ 2-S Hours ❑ Waste Water <br />� CODE: ❑ Misc ❑ Detect ❑ Fval ❑ Reined ❑ Demol ❑ Closure ❑ Other <br /> Client Date/Time Matrix # of Cant Laboratory g <br /> Sample I D Sampled Desc Cont Type Sample# Comments <br /> 1 Qq r�✓ 9S K.K Sa t f ►" z' <br /> `(� o <br /> 2 (AL4 —qo —tai=fir <br /> 3 Q r; - 10 �' I� �r5— (�'fa D 1 7C <br /> , <br /> 4 u — SSVOID <br /> X o <br /> 5 X °J <br /> } <br /> 6 ub - <br /> 1W3 <br /> 8 U� �` � - �'° Its <br /> y10 � r3 o <br /> L <br /> O <br /> -0 <br /> Relinquished By Date WwAir Time 1't�5 Received B Date 7 z ime S —c' <br /> Relinquished By Date 717; S— Time /J— Received B Date Time <br /> Reim wished S Date Time Received B La ate 1q5JT,me aj <br /> Were Samples Received in Good Conditions es O No Samples on Ices ta<es O No Method of S ment-,<:�e(f6"o 14 Page 7—of3 <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 />