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G 680 Chesapeake Drive•Redwood City,CA 0.(415)364 9600 r_] 18939 120th Ave,N E,Suite 101 •Bothell,WA 980110)481 9200 <br /> UCAL A819 Striker Ave, Suite 8•Sacramento,CA 95834•(916) 921-9600 U East 11 115 Montgomery,Slllte B•Spokane,WA 99206•(509)924 9200 <br /> rJ 1900 Bales Ave,Suite LM•Concord,CA 94520•(510)686 9600 U 15055 S W Sequoia Pkwy,Suite 110•Portland,OR 97222•(503)624 9800 <br /> Protect Name <br /> Company <br /> Name �� f��C �t?U1fU��t�.iP,,1 -tl � C-figg 7Z) r'k1r;Y <br /> ddress '102- 5, t%dl QO ��4'e e. �`��1f 0 UNOCAL Protect Manager p 6 V`0a� -` <br /> City n �O s e� State /� Zip Code e751119 Release# �) �7 C9 .CI �` <br /> Telephone 1 tf - 7 a FAX # 1/90 75.E f Site If <br /> Re ort To � bic °t t�e S v, Sampler for NJ"' t 6/(r QC Data Level D (Standard) ❑ Level C ❑ Level i3 ❑ Level A � <br /> Turnaround �w Work Days ❑ 5 Work Days ❑ 3 Work Days ❑ Drinking Water Anal ses Requested <br /> Time. ❑ 2 Work Das ❑ 1 Work Day ❑ 2-8 Hours ❑ Waste Wat <br /> CODE: ❑ Misc ❑ Detect ❑ Eval ).Aemed ❑ Demol ❑ Closure �_J Other <br /> Client Date/Time Matrix #of Cont Laboratory �) <br /> Sample I D Sampled Desc Cont Type Sample It Comments <br /> s� <br /> �C G_ 9z }� <br /> 3 <br /> 3 <br /> o <br /> a� <br /> i <br /> 5 <br /> 6 <br /> 7 <br /> 9 I <br /> 9 <br /> 10 <br /> o <br /> .a <br /> c� <br /> Relinquished By ' Date TimeReceived By <br /> Date Time ' <br /> Relinquished By Date Time Received By Date Time <br /> Relinquished By Date Time Received By Lab Date Time <br /> Were Samples Received in Good Condition?Q Yes❑ No Samples on Ice? 0 Yes 0 No Method of Shipment Page at <br /> To 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 still needed? --- -- ---- <br /> 2) Was the report issued within the requested turnaround time? iD Yes IJ No If no, what was the turnaround time? -- — --- <br /> Approved by __ _ __ _�_ __�_—__Signature _____-___ ___r_--- _ -- Company ----_—_-_- _ _-- _ - --Date <br />