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❑ 680 Chesapeake Drive-Redwood City,CA 94063•(415)364-9600 ❑ 18939120th Ave.N E,Suite 101 -Bothell,WA 98011•(206)481-9200 <br /> UNOERL0 <br /> ❑ 819 Striker Ave,Suite 8•Sacramento,CA 95834•(916)921-9600 13East 11115 Montgomery,Suite B•Spokane,WA 99206•(509)924 9200 <br /> ❑ 1900 Bates Ave,Suite LM•Concord,CA 94520-(510)686-9600 ❑ 15055 S W Sequoia Pkwy,Suite 110-Portland,OR 97222-(503)624-9800 <br /> Company Name - `^ Project Name <br /> Address 56-3:5. 5 t, U UNOCAL Project Manager <br /> I <br /> City a"O a",p_State C4 Zip Code q <br /> Telephone SV —13 I y F IX# 6�j� —(31 Site # �_ <br /> U <br /> ,Report To isampler q6vc QC Data Level A (Standar(=) ❑ Level B ❑ Level C ❑ Level D <br /> Turnaround: ❑ 10 Working Days 1:12 Working hays C1 Drinking Water Anal ses Re——u—est—ed a <br /> Time ("&5 Working Days 1:124 Hours ❑ Waste Water <br /> ❑ 3 Working Days ❑ 2 - g Hours ❑ Other <br /> Client Datelrime Matrix # of Cont <br /> Laboratory !Q�{ <br /> Sample 1 D Sampled Dese Cont Type Sample# Comments <br /> 2 0 <br /> 5!� <br /> 3 m <br /> 4 <br /> 0 <br /> 5 <br /> 6 <br /> 7 <br /> I ' <br /> S <br /> 9 <br /> 110 <br /> 0 <br /> tT <br /> cn <br /> Relinquished By Date--l/ Time f y-10 Received B \� Date 7 // ime m <br /> Relinquished By isLc,� O Date? (� Time f^p6 Received B Date Time <br /> Relin uished By Date Time Received By Lab I Date Time <br /> Were Samples Received in Good Condition?ErYes Q No Samples on Ice? a-Yes❑ No Method of Shipment 'Nen*,0 Edt. Page of <br /> To be competed upon receipt of report 00 <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? O Yes❑ No If no, what was the turnaround time? <br /> Approved Signature Company p <br />