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❑ 680 Chesapeake Drive•Redwood City,CA 94063•(415)364-9600 ❑ 18939120th Ave,N E,Suite 101 •Bothell,WA 96011 •(206)481-9200 <br /> UNOEFILO . <br /> ❑ 819 Stnker Ave,Suite 8•Sacramento,CA 95834•(916)921-9600 ❑ East 11115 Montgomery,Suite B•Spokane,WA 99206•(509)924 9200 <br /> 1900 Bates Ave,Suite LM•Concord,CA 94520•(510)686-9600 0 15055 S W Sequoia Pkwy,Suite 110•Portland,OR 97222•(503)624-9800 <br /> Company Name6�� { G Project Name `s 7-:?- <br /> 03 <br /> Address 3635 UNOCAL Project Manager T(yn t;/awa,1,CJ <br /> City a,,tIJAIc7 <g,r _State {'jd- • Zip Code X56 �j r✓1 P.� <br /> Telephone FAX# i�5-1 /Z Site # <br /> m <br /> ,Report To 4�".[,v2 CAII iSamplerCD-JtAl' QC Data O.Level A (Standard) ❑ Level B ❑ Level C ❑ Level D <br /> Turnaround g 10 Working Days ❑ 2 Working Days ❑ Drinking Water 1Analyses Requestedl Requesteda <br /> Time ❑ 5 Working Days ❑ 24 Hours ❑ Waste Water <br /> ❑ 3 Working Days ❑ 2 - 8 Hours ❑ Other <br /> Client Date/Time Matrix #of Cont Laboratory <br /> Sample 1 D Sampi 2d Desc Cont Type Sample # Comments <br /> 1 VIM C* sar/ �, a <br /> 4l <br /> 3ItM <br /> 4 <br /> 5 <br /> } <br /> 6 <br /> 8 <br /> 9 <br /> 10 0 <br /> 0 <br /> a� <br /> Relinquished By Date //-j Time V:0 Received Date lme 16 a� <br /> L <br /> Relinquished By' Date 7 !/ Time 4W Received Date Time <br /> Relinquished BV I Date Time lReceived By Lab I Date iTime lito fz,,C� <br /> Were Samples Received In Good Condition? `Yes ❑ No Samples on Ice? ZkYes❑ No Method of Shipmentwit <br /> Page-of 7/aro <br /> I <br /> To be completed upon receipt of report <br /> 1) Were the analyses requested on the Chain of Custody reported? ❑Yes a 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 timb. Signature Company D <br />