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-'r-- - •G ,«u"UVUUi+y,un yNUbd•:415 ;b4VOW U 16939 120th Ave,N E,Suite 101 •Bothell,WA 98011 •(206)481 9 00 <br /> UA L f Q 819 Sinker Ave,Suite 8•Sacramento,CA (91 6)921-9600 Q East 11115 Montgomery,Suite 8•Spokane,WA 9920)924 9200 <br /> ❑ 1900 Bates Ave,Suite LM•Concord CA 94 <br /> , 52t�(510)686-9600 ❑ 15055 S W Sequoia Pkwy,Suite i 10•Portland,OR 97222. 503 624-9800 <br /> t ) <br /> Company Name 67-" Project Name L1 g-7 <br /> Address 30-;':5 i-ro s Lo � #0/-, - to UNOCAL Protect Manager ���, ��S�~ <br /> City 4c o (fi -)d>V o,- State CA Zip Code g156 7-0 Release# <br /> Telephone / tom-- a <br /> r--f 3G FAX # 6'� Site# (N S � <br /> Report To Sam ler S• �-' 41r,� U <br /> QC Data d Level D (Standard) ❑ Level C ❑ Level B ❑ Level A <br /> Turnaround ❑ 10 Work Days 45 Work Days 1:13 Work Days ❑ Drinking Water <br /> Time g Anal ses Requested <br /> ❑ 2 Work Das ❑ 1 Work Day ❑ 2-8 Hours ❑ Waste Water <br /> CODE: ❑ Misc ❑ Detect ❑ Eval ❑ Remed ❑ Demol ❑ Closure ❑ Other Qj <br /> Client Date/Time Matrix #of Cont Laboratory <br /> Sample I D Sampled Desc Cant Type Sample# Comments <br /> Z so-d X <br /> 2 ° <br /> L <br /> 0 <br /> 3 <br /> 4 <br /> 3 <br /> 5 ° <br /> 6 <br /> 7 <br /> 8 <br /> 9 <br /> 10 .......... L' <br /> 0 <br /> ro <br /> L <br /> Relinquished B i <br /> q Y Date 2( `JS Time 'r S Recei:dB Date? Zf Time S� <br /> Relinquished By Date x/ $� Time <br /> fs Received B Date Time <br /> Relinquished By Date ITimeI Received By Lab <br /> ate Time <br /> Were Samples Received in Good Condition?eYes a No Samples on Ice? es 0 No Method of Shi meat �Lld iG� Page of 3 <br /> To be completed upon receipt of report <br /> 1) Were the analyses requested on the Chain of Custody reported? ❑Yes O No If no, what analyses are still needed? <br /> 2) Was the report issued within the requested turnaround time? ❑Yes O No If no, what was the turnaround time? <br /> Approved by Signature Company Date <br />