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680 Chesapeake Drive•Redwood City,CA 94003 -0(916) <br /> 5)384 9600 U 18939120th Ave,N E,Sulle 101 •Bothell,WA 98011 •(2�1 9200 <br /> U 819 Sinker Ave,Suite 8•Sacramento,CA 958 921-9600 U East 11115 Montgomery,Suite 8• i <br /> UNOfAL � 9 rY, Spokane,WA 99208 (509)924 9200 + <br /> U 1900 Bates Ave,Suite L.M•Concord,CA 94520•(510)686 9600 U 15055 S W Sequoia Pkwy,Suite 110•Portland,OR 97222•(503)624 9800 <br /> Company Name Q�IrC E1JAwmac- Project Name -- <br /> Address �' , L�L�� UNOCAL Project ManagerT� <br /> CITY 11 rr State Zip Cade U Release # <br /> Telephone �"L - - PAX# (D <br /> - - J Site # 205 v <br /> Report To E Sam ler ' <br /> � L� wq DrX QC Data evel D (Standard) ❑ Level C ❑ Level B ❑ Level A " <br /> Turnaround 6 10 Work Days ❑ 5 Work Days ❑ 3 Work Days ❑ Drinking Water JAnalyses Requested °" <br /> Time ❑ 2 Work Das ❑ 1 Work� Da ❑ 2-8 Hours IJ Waste Water <br /> CODE: ❑ Misc CJ Detect ❑ Eval ❑ Remed ❑ Demol ❑ Cl6sure Cher <br /> Client Dale/Time Matrix #of Cont Laboratory <br /> Sample 1 D Sampled Desc Cont Type Sample # Comments <br /> INX '51),.�b 21 <br /> lk 0 <br /> 3 CU <br /> 4 3 <br /> 0 <br /> 5 as <br /> 7 <br /> Ei <br /> 9 <br /> 10 <br /> 0 <br /> m <br /> 0 <br /> Relinquished By Date , ,� Time Received B Date Time _moi <br /> Relinquished By Date Time Received By Date Time <br /> Relinquished By J Date Time Received By Lata Date Time <br /> Were Samples Received in Good Condition?❑Yes❑ No Samples on Ice? ❑Yes No Method of Shipment Page 0f <br /> To be completed upon receipt of report <br /> 1) Were the analyses requested on the Chain of Custody reported? t1 Yes❑ No It no,what analyses are still needed? — <br /> 2) War, Ilio reknit t,suoa within III() 1odii0s4od 1iunn1rxincl 111110? 1-1 Yos iJ No If ne, what wus Iho lurnrirrnmrl limo? -� --- - - <br /> Approved by _ ----Date <br /> �.__ Signature _ _-�_ ___-� _____ ---Company <br />