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❑ 680 Chesapeake Drive•Redwood City,CA 94063•(415)364-9600 ❑ 18939 1201h Ave.,N.E.,Suite 101•Bothell,WA 98011 •(206)481-9200 <br /> U1 O /� 1-1819 Striker Ave.,Suite 8•Sacramento,CA 95834•(916)921-9600 ❑ East 11115 Montgomery,Suite B•Spokane,WA 99206•(509)924-9200 <br /> 'V „ I <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: G I Project Name: 1� 1–t mai rnC L- <br /> Address: 1� I� Su o L rTz��e UNOCAL Project Manager: <br /> City. ICA,-j (_hC) ppvA State: C)) Zip Code 9j 7y Z AFE #: q��r +�j,�l oSco -At'Ecz 158 b <br /> Telephone: Q\U 3sic Z3:�_D FAX#: 'tI1,, 8EB Z3 v� Site#, City, State: zo? J <br /> Report To: 1l vS �P�` Sam ler v� R� QC Data: Level D (Standard) ❑ Level C 0 Level B ❑ Level A <br /> IL <br /> Turnaround 10 Work Days 5 Work Days ❑ 3 Work Days ❑ Drinking Water JAnalyses Re uested <br /> Time: U 2 Work Das ❑ 1 Work Day ❑ 2-8 Hours ❑ Waste Water " /�c/CODE: Misc. ❑ Detect. ❑ Eval. ❑ Remed. ❑ Demol. Closure Other4iW <br /> Client Date/Time Matrix # of Cont. Laboratory .151 <br /> Sample I.D. Sampled Desc. Cont. Type Sample# y(� �p rL �� O Comments <br /> X x ✓� S <br /> 3:40 W VgyavS <br /> X 2 <br /> 2. 5�1 -� 1930 5 Ca <br /> �Ltn .1 6�L0 <br /> 314,io 0 J <br /> 0 <br /> 4 S�3 14.'SD 4 X 1 - <br /> 5 } <br /> 6 <br /> 7 <br /> 8 <br /> 9, <br /> 0 <br /> 10 � <br /> `o <br /> ro <br /> J <br /> Relinquished By: /9 4 Time: G Received B : Date:/// h 7Time: <br /> a� <br /> Relinquished By: Date:// Time: D Received By: Date: Time: <br /> Relinquished B Date: Time: Received BV LabDate:�I Time: <br /> Were Samples Received in Good Condition? Yes 0 No Samples on Ice? �Irlyes O No Method of Shipment Sf 4-41,01i1 Page 7 of <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? O Yes L] No If no, what was the turnaround time? <br /> Approved by: _ _ Signature: -------Company: Date: <br />