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® t�A 9465 00 y,lgwAve J�Sude=©vlh�9i3 '� <br /> O 68 esapeane urrve• � ood � , <br /> NWA 1, O 819 striker Ave,Suite 8•Sacramento,CA 95834•(918} 21-9600 U East 11115 Montgomery.Suite B-Spokane,WA 99206 9)924 9200 <br /> Q 404 N Wiget Lane•Walnut Creek,CA 94598•(925)988 9600 0 15055 S W Sequoia Pkwy,Suite 110•Portland,OR 97222•(503)624 9800 <br /> ❑ 1455 McDowell Blvd North,Suite D•Petaluma,CA 94954•(707)792 1865 <br /> Consultant Company & &eje,' EVca,, Imo= ;� � #2.1010`"- Y Project Name Fp orw A pert <br /> Address ? CBur�' S.":.f4 cT UNOCAL Project Manager Hr Bak <br /> City b Ljb11 n State (f-10k Zip Code gqS6 g AFE # <br /> rs,� FAX # rLr) sS"1- '8 9 Site #, City, State -&6 112c ` ^c- <br /> Telephone X7,5) ��f•- r L <br /> ,� ►, Sampler >< l t TQ s f ', OC Data Level D (standard) ❑ Level C ❑ Level B D Level A <br /> Report To b aar nde " <br /> Analyses Requested a <br /> Turnaround 10 Work Days © 5 Work Days ❑3 Work Days 0 Drinking Water Y <br /> Time. © 2 Work Days 0 Mork Day ❑2-8 Hours J Waste Water .-t-- <br /> CODE: o Mise 0 Detect ElEval U Remed ❑ Demot U Closure I <br /> U Other p <br /> Client DatelTime Matrix # of Cont I Laboratory > '\ U� Comments <br /> Sample I D Sampled Desc Coni Type Sample # <br /> 2 <br /> y.�a 1 vt7 A� 906A 6' X R <br /> c <br /> 906856:3 <br /> 3 mw' 1✓� L PA Y 906JL5(a <br /> 7- 90 <br /> a w- j 1 s Pw! t �- 656 ) a <br /> z 4 90 f L <br /> s 12 °�*+ Z ti 906156'7 X <br /> .- s �tj,f- ►3 . it <br /> ti <br /> 8 JAty, N, � l►'iAt 906156 X <br /> Zf f� 9061570 <br /> 1Q A4 w , !6 33 a P z 906517 <br /> Relinquished By ' Date Time �;f�,Q Received By Date Time <br /> �} 1 <br /> Relinquished By ; ` , ( L Q C`v-e Date {off r Time Received By Date f�'�S� Time 9 <br /> ale �-/ Time et) Received y Lab Date6//B/1Time 19:0e <br /> Relinquished By �v`� l <br /> Were Samples Received to Good Condition? ❑Yes 0 No Samples on Ice? Q Yes 0 No Method of Shipment Page of Z <br /> Zo be completed upon receipt of report <br /> 1)Were the analyses requested on the Chain of Custody reported? ❑Yes ❑ No If no, what analyses are stiff needed? <br /> 2)Was the report issued within the requested turnaround time? D Yes ❑ No If no, what was the turnaround time? <br /> Approved by __ Signature Company Date <br />