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U 680 Chesapeake Dave•Redwood City CA 940 15)364 9600 J 18939 120th Ave,N E Suite 101 •Bothell WA 98011 •(21-9200 <br /> UA L I U 819 Striker Ave,Suite 8•Sacramento CA 95814• 16)921-9600 U East 11115 Montgomery Suite B•Spokane WA 99206•(501,24 9200 <br /> U 404N Wlget Lane•Walnut Creek CA 94598-(510)988-9600 U 15055 S W Sequoia Pkwy Suste 110•Portland,OR 97222-(503)624-9800 <br /> Consultant Company &E�L ���� In � Protect Name (,l Q�'(�� y <br /> Address G �-11 S i Ext Q C4�- 5,t-e- UNOCAL Protect Manager [:-7V R R O T Q AJ <br /> City D U13LI N State C fl Zip Code � j�j AFE# � <br /> Telephone 15M� ` ~ J S �j FAt T�[X# 5-51— Site#, City, State ``� 30 3 �'R e t �� c A-V E, <br /> Re ortTo CLYI)t GRONMu Sam ler " WG_ K VQ OC Data 2- Level D (Standard) ❑ Level C ❑ Level B ❑ Level A <br /> Turnaround 0 rk a,9 r s ❑ 3 Work Days ❑ Drinking Water Anal ses Requested <br /> Time ❑ 2 Work Das 1 Work Da ❑ 2-8 Hours 13 Waste Water <br /> CODE' ❑ Misc ❑ Detect d ❑ Demol ❑ Closure Other <br /> Client Datefrime Matrix # of Cont Laboratory <br /> Sample l D Sampled Desc Cont Type Sample# Comments <br /> I US - 13 t 91/9950)L a ILI g <br /> 2 Ul5 t r� 804:141 0 <br /> 3 Lis^ t 5" 8041417 <br /> 4 <br /> �� C, 0 O <br /> 5 <br /> } <br /> 6 <br /> 7 <br />� 8 <br /> 9 <br /> a <br /> 10 � <br /> L <br /> Relinquished By Date 1 ime Received By Date Time J <br /> m <br /> Relinquished By Date Time Received By Date Time <br /> Relinquished By I Date ITime Received By Lab Date Time CJ <br /> Were Samples Received in Good Condition? -fes a No Samples on Ice? lktres r-i 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? U Yes❑ No If no, what was the turnaround time? <br /> Approved by _ �_____ ___ _____ Signature __ _ —___ _ Company __� _�Date <br />