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❑680 Chesapeake Drive•Redwood City,CA 94063•(650)3100 U 18939 120th Ave, N E Suite 101 •Bothell,WA 98011 •(206 9200 <br /> uA L O 819 Sti iker Ave,Suite 8•Sacramento,CA 95834•(916)921- 600 O East 11115 Montgomery Suite B•Spokane,WA 99206•(5 4-9200 <br /> ❑404 N Wiget Lane•Walnut Creek,CA 94598•(925)988 9600 U 15055 5 W Sequoia Pkwy, Suite 110•Portland,OR 97222•(503)624-9800 <br /> Q 1455 McDowell Blvd North,Suite D•Petaluma,CA 94954•(707)792 1865 <br /> Consultant Company X./cal '70b #Ztlo10 s4c' 8-5- Project Name Fa rMe/ Acct SS >-7) <br /> Address 6-7-y ? Star/a. Cdu�`�� S�-�f� cT UNOCAL Project Manager /Hr Bab <br /> City b LibIl n State (=,at Zip Code 9q.5-6 g AFE # Q4111 R 19 1 <br /> Telephone (pr) sir,- "S FAX #Qgzr)SS"1- �8 Site #, City, State %7&6 pQG ` Adds'" ' <br /> Report To bea,4 nat 1, f Qro�m7 Sampler Y S TQ S h 'f CC Data Level D (Standard) Q Level C ❑ Level B ❑ Level A <br /> /d_ 10 Analyses Requested � <br /> Turnaround /_10 Work Days ❑5 Work Days 0 3 Work Days ❑ Drinking Water Y q tf <br /> Time. ❑ 2 Work Days D 1 Work Day ❑2-8 Hours 0 Waste Water Y/ <br /> CODE: O Misc ❑Detect 0 Eval 0 Remed Q Demol ❑Closure U Other <br /> O <br /> Client Date/Time Matrix # of Cont Laboratory @> ID Comments <br /> Sample 10 Sampled Desc Cont Type Sample # <br /> T <br /> 1 77_ t=� t'1H1 o I v6A, 90(;3.562 X 16 <br /> o <br /> — 2 Ho <br /> - 10 ft��uf z 906156,3 0 <br /> 3 Mw� <br /> S7 f ty Z tio <br /> 4 w• r 1 ®6856 X <br /> } <br /> s m Iv zY z 4 906156 K <br /> 6 Mw- f3 iIPA"M z 906156 ' X <br /> 04G N 90t; <br /> 8 N+IV !`F �— •c 9®6156 K <br /> 9 M V- 1 90( 15' 0 <br /> 10 1.4w , �6 �if'�1 4 Z �-- 9®6157' ca <br /> J <br /> Relinquished By Date Time q:[ Received By Date 6�8 Time <br /> Relinquished By ', �, t <br /> C � Date {o j Time Received By Date 1/0154 <br /> 0f 54 Time 9 <br /> c` `t <br /> Relinquished By — ate `� 7 Time ( c� Received y Lab Datedol/6/ Time 19,4041 <br /> Were Samples Received in Good Condition? ❑Yes 0 No Samples on Ice? ❑Yes ❑ No Method of Shipment Page 1 of Z <br /> Ta be compteted upon receipt of report <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? ❑Yes ❑ No If no, what was the turnaround time? <br /> Approved by Signature Company Date <br />