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,1 680 Chesapeake Drive•Redwood City,CA 94063•(415)364 9600 ❑ 18939 120th Ave,N E,Suite 101 •Bothell,WA 98011 -(206)481-9200 <br /> UNOCAL <br /> NOCAL ❑ 819 Striker Ave Suite 8•Sacramento,CA 95834-(916)921-9600 a East 11115 Montgomery,Suite B-Spokane,WA 99206•(509)924-9200 <br /> ❑ 404 N Wiget Lane•Walnut Creek,CA 94598•(510)988-9600 ❑ 15055 S W Sequoia Pkwy,Suite 110•Portland,OR 97222•(503)624-9800 <br /> Consultant Company 64e �r qK Project Name Z <br /> Address (07'17 Sico rel C� Sc,fe I 1%71,62,a z UNOCAL Project Manager f_SEM� <br /> City l i A State Zip Code �� AFE# <br /> Telephone (SID) SS L IS. S FAX# Ic SE�I Site #, City, State SLA Zl � , m <br /> Re ort To tIC�''c�f`✓lC ISampler 1. q ftc,'` t-•�e <br /> e QC Data ❑ Level D (Standard) ❑ Level C ❑ Level B ❑ Level A <br /> Turnaround 10 Work Days ❑ 5 Work Days ❑ 3 Work Days ❑ DrinkingWater C a. <br /> Anal ses Requested �0`�AIS <br /> Time 2 Work Das A 1 Work Day ❑ 2-8 Hours ❑ Waste Water <br /> �. <br /> CODE- ❑ Misc Detect ❑ Eval ❑ Remed ❑ Demol ❑ Closure ❑ Other 'Z, <br /> Client Date/Time Matrix #of Cant <br /> Laboratory <br /> Sample I D Sampled Desc Cant Type Sample# �j� �► �� )lComments <br /> 3 tuJ <br /> OYX `� <br /> -7 2 <br /> _T 7 CS } <br /> t- - j '�� l <br /> 7 LA 1-&/-b <br /> 8 <br /> 9 <br /> 10 a <br /> co <br /> o <br /> Relinquished By ate S Time �'�� Received B Date `(� q Time ('Uti <br /> Relinquished By Date ;bi %Timer <br /> Q't} Received B '!Kcr'�_ Date Time c1ck <br /> Relinciuished8v Datet��14 1a' 9y� <br /> Time Received By Lab Date <br /> Were Samples Received in Good Condition?❑Yes❑ No Samples on Ice? ❑Yes Ct 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 O No If no,what analyses are stili needed? <br /> 2) Vs the report issued within the requested turnaround time? a Yes❑ If no,what was the turnaround time? <br /> Apf Signature Company <br />