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UN� n/~L � U 819 Sinker Ave Suite 8•Sacramento,CA 958016)921 9600 0 East 11115 Montgomery,Suite B•Spokane WA 99206*.#24-9200 <br /> Y U 404 N Wirget Lane-Walnut Creek,CA 94598•(510)988 9600 ❑ 15055 S W sequoia Pkwy,Suite 110•Portland OR 97222 24 9800 <br /> Consultant Company . 11�C Protect Name Uos' , 7e- - <br /> - Oncrm <br /> Address qf L b UNOCAL Protect Manager <br /> City ,(�llswsState �' Zip Code AFE # <br /> Telephon `ICS - 7�t FAX # 7,57Site it, City, Stale ) <br /> U <br /> Re ort To L isampler C9v�t,C) QC Data vel D {Standard} ❑ Level C ❑ Level B ❑ Level A <br /> Turnaround Work Das ❑ 5 Work Das ❑ 3 Work Da <br /> Y Y Ys ❑ Dunking Water JAnalyses Re uested <br /> Time ❑ 2 Work Das ❑ 1 Work Da ❑ 2-8 Hours ❑ Waste Water <br /> CODE: ❑ Misc I tect ❑ Eval ❑ Remed ❑ Demol ❑ Closure �tfler <br /> n <br /> Client Date/Time Matrix # of Cant Laboratory <br /> Sample I D Sampled Desc Cant Type Sample# Comments <br /> i CL�7 -42% 12 co <br /> 0 <br /> 0 <br /> 3 <br /> 4 0 <br /> m <br /> 5 }. <br /> 6 <br /> 7 <br /> B <br /> 9 <br /> 110 0 <br /> 0 <br /> ,n <br /> m <br /> Relinquished By Date JW% Time Received By Date Time <br /> a� <br /> Relinquished By Date Time Received By Date Time <br /> Relinquished By I Date Time Received By Lab I Date ITime <br /> Were Samples Received in Good Condition?❑Yes ID No Samples on Ice? ❑Yes U No Method of Shipment Page_Of <br /> To be completed upon receipt of report <br /> 1) Were the analyses requested on the Chain of Custody reported? ❑Yes U No If no, what analyses are still needed? <br /> 2) Was the report issued within the requested turnaround time? rJ Yes U No If no, what was the turnaround lime? <br /> Approved by Signature Company <br /> Date <br />