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U 180 Chesapeake Drive•Redwood C,iy,GA 111163,'115,361 9600 U 18949 11011,Ave,11 I<,bu,le iu, •uu,1i1,11,111, allu,r lluu, V 1 <br /> UNOERL O 819 Striker Ave,Suite 8•Sacramento,CA 95834•(916)921-9600 G East 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,Surle 110•Portiand OR 97222•(503)624 9800 <br /> Company Name � �c `-��ty �c���\�, t� Project Name <br /> Address 'ZiAv\ C�\ �F\� Q�\�1`� ����� \, �`` UNOCAL Project Manager V <br /> City <ZSAUJU Stale Q� Zip Code"\`�51� Release # <br /> Telephone 51�� ���. 5\ FAX # —\ GQQ`L Site #.�� Um <br /> c <br /> [Reeorl To VO ISampler \ - - QC Data Level A(standard) ❑ Level B ❑ Level C ❑ Levet D ti { <br /> Turnaround'� 10 Working Days ❑ 2 Working Days ❑ Drinking Water Anal ses Requested] <br /> Time. ❑ 5 Working Days ❑ 24 Hours ❑ Waste Water <br /> ❑ 3 Working Days ❑ 2 -8 Hours 1�4 Other R,w <br /> Client Date/Time Matrix # of Cont Laboratory <br /> Sample I D Sampled Dese Cont Type Sample # Comments <br /> 2 ° <br /> 3 <br /> 4 0 <br /> N <br /> 5 } <br /> 6 <br /> 7 <br /> 8 <br /> 9 <br /> 10 <br /> o <br /> 0 <br /> Relinquished By � Date r `4 Time 133© Received By Date Time —J <br /> Relinquished By `��__ Date Time Received By Date. Time <br /> Relinquished By-- Date Time Received l r �'��" � [DatITime `33 <br /> ' Were Samples Received in Good Condition?kes O No Samples on Ice?9Yes Q No Method of Shipment Page-�'of <br /> ` o be completed upon rece pt of report <br /> r 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❑No If no, what was the turnaround time <br /> App&by Signature Company to <br /> i <br />