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®�se4MPee9M-Iia a4W4oC.VW1 = tW 1209M,N AM 141 IMen,V191 I• <br /> 619 61riksr Ave,Suite 8•Sacramento,CA 95834•(918)92 940 ❑East 1 1115 Montgomery,Suite B•Spokane.WA 99206•(508)924-9200 <br /> a 404 H Wiget Lane•Walnut Creek,CA 94598•(925)966-9600 ❑15055 S W Sequoia Pkwy,Suite 110■Plortfand,OR 97222•(503)924-9800 <br /> V) <br /> d 1455 McDowell Blvd North,Sues d•ftWuma,CA 94954-(707)792-1896 <br /> Consultant Company ►Jv,� Project Name <br /> 03 <br /> ° Address <br /> :�3 UNOCAL Protect Manageraso <br /> City MiteCA Zip Code I VJq5 AFE#: <br /> m Telephone FAX #- 181- Site#, City, State CA <br /> c <br /> Report To. Samibowpler t� OC Data. )'Level D(standard) ©Level C I]Level B t1 Level A v <br /> T MMKind )<10 Worts Days ❑5 Work Days ©3 Work Days ❑ DrmYJng Water Analyses Requested Y <br /> Ttrrlt: Cl 2 Work Days ❑Mork Day ❑2-8 Hours <br /> ❑Wastewater a. <br /> CODE: 13 Miac Q Detect ❑Eva] 13 RemedL ❑ Demol. f1 Closure XftSr <br /> ry w <br /> Client Date/Time Matrix #of Cont Laboratory Comments <br /> Sample I D Sampled Desc. Cont_ Type Sample# <br /> Z S S-r1�►,tZ?� n- - IZ Sa�L. 1 �reiEv� —011/0 n <br /> I <br /> CE 7 LIC[A <br /> Lo 9 - I+t2t:t� ;� Cl a <br /> 10 -;*v:Z171-0 -Zook MA L° <br /> D <br /> cc <br /> Relinquished By Date Time' Received By ���; Date Time <br /> s <br /> Relinquished By. Date Time Received By hate Tune <br /> Relinquished By: Date Time Received By Lab Date Time / �p <br /> m Were Samples Received in Good Cand€iion? ❑Yes U No Samples on I(e? ❑Yes ❑No Met of Shipment-_ � rape�at Z <br /> Z: To be completed upon receipt of report <br /> 1)Were the analyses requested on the Chain of Custody reported'? CQYes Q No If no,what analyses are stilt needed? <br /> 2)Was the report issued within the requested turnaround time) DYes ❑No It no, what was the turnaround timet <br /> Approved by Signature ComFanY Date <br />