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U 680 Ghesapeake Drive•Hedwood Uly,GA 9406)•(650) 400 U IbVj!j l2om Ave,N E Suite 101 •Bothell,WA 98011 •(20 9200 <br /> UN&ALU B19 Striker Ave Suite 8•Sacramento,CA 95834•(916)921= 600 Q East 11115 Montgomery,Suite B•Spokane,WA 99206•(�24-9200 <br /> U 404 N Wiget lane•Walnut Creek,CA 94598•(925)988 9600 U 15055 S W Sequoia Pkwy,Suite 110•Portland,OR 97222•(503)624-9800 <br /> U 1455 McDowell Blvd North,Suite D•Petaluma CA 94954•(707)792 1865 <br /> Consultant Company Geta' ��yan rrnC, .#Zg6[J `�� s Project Name Fof- 7r'r r,1r uc Qd/Z 3 <br /> Address 47yUNOCAL Project Manager pe .Gab 8ocx -/- <br /> City State C Zip Code Cj y 69 AFF # ; ! f} 8 <br /> Telephone�9z S-) 5-5-7-7 S 5s, FAX #C7-40 sSj---849 Site #, City, State 62�,17!6J AV" TrI&C a <br /> Report To Z>&nnr Q Sampler tfc; s T •1 Q„ QC Data Level D (standard) ❑ Level C 13Level B El Level A <br /> U <br /> Y <br /> Turnaround � 10 Work Days O 5 Work pays ❑3 Work Days ❑ Drinking Water JAnalyses Re q uested a <br /> Time ❑ 2 Work Days ❑ 1 Work Day U 2-8 Hours Waste Water <br /> CODE: ❑Misc ❑Detect U Eval U Remed U Demol U Closure U Other <br /> Mlly <br /> Client Date/Time Matrix # of Cont Laboratory ��Q �� Comments <br /> Sample I D Sampled Desc Cont Type Sample # <br /> a <br /> j �� g 06130'7 ° <br /> 1 TB- SB L U <br /> TP - b m <br /> L <br /> 2 W - J iz�PMz: 6130BA- �( x ?� <br /> 1p -t' 0 <br /> 3 U- -c 3 <br /> 4 c!- 3 raz .� 9 61310 X x <br /> 5 <br /> j /P�+ 0 1 <br /> sJoy 9 61312X X <br /> 7 <br /> 8 <br /> 0 <br /> 9 <br /> 0 <br /> 10 <br /> Relinquished By {J Dated / Time �Zo Received By Date (� Jq Time �ZO <br /> Relinquished By Date Sy Time 0 Received Byate , - Time <br /> Relinquished 8y //� ate i�' Time / 9�j RecelvedDate E✓151� Time <br /> Were Samples Received in Good Condition9 ❑Yes O No Samples on Ice? ❑Yes Cl 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? U Yes ❑ 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 /> - <br /> r x <br />