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O 6�sape ve-11ROd COW IP15)AW10 E18930W AveMWSud Bot�A9 00U AA L , ❑ 819 Sinker Ave,Suite 8•Sacramento,CA 9916)921-9600 ❑ East 11115 Montgomery,Suite B-Spokane,WA 99206•TO � 24 9200 <br /> 0 404 N Wiget Lane-Walnut Creek,CA 94598•(510)988-9600 0 15055 S W Sequoia Pkwy,Suite 110•Portland,OR 97222•(503)624-9800 <br /> 1"Consultant Company • t.+�, Project Name - -Wok C <br /> Address /31 S 5ki4 t✓ Co (,'r8e. -"rvk UNOCAL Project Manager o to &-,5 I <br /> city 4.1C1X, rcjoVq State Zip Code C759$;Z AFE# 0 - p( <br /> Telephone +lG s�r Z5 SC' FAX# <br /> �� �S$ Z3 �S Site#, City, state Q 23 �C �- � <br /> Report To i `>Y ,t Sam ter LLt 4-tP' QC Dataevel D (Standard) ❑ Level C ❑ Level B ❑ Level A <br /> Turnaround ,thy( A5 Work Das ❑ 3 Work Das <br /> Y Y ❑ Dunking Water lAnal ses Requested] <br /> Time ❑ 2 Work Das ❑ 1 Work Day ❑ 2-8 Hours gLWaste Water 144 <br /> CODE: Misc ❑ Detect ❑ Eval ❑ Remed ❑ Demol ❑ Closure ❑ Other <br /> Client Dalefftme, Matrix #of Cont Laboratory <br /> Sample I D Sampled Desc Conk Type Sample# Q� �' �`� Comments <br /> 1 V — r r U a S U CD.-� �O 0 <br /> 3 <br /> 4 Oat <br /> Ifrl o <br /> 5 S } <br /> 6 <br /> 7 <br /> 8 <br /> 9 <br /> 10 <br /> 0--22 <br /> 0 <br /> Relinquished By Date Time/-)7-"PO O ll <br /> >! Received 8 Dat 5� Time 17. <br /> S LD J <br /> &0w <br /> Relinquished By Dat4)�a-v Timet+35- Received By Dat Time <br /> -Relinquished Bv I Date ITime I Received B b dadd me,LL <br /> Y� <br /> Were Samples Received in Good Condition?U Yes Q No Samples on Ice? ❑Yes❑No Method of Shipment Page Jof <br /> To Se 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? ❑ Yes Q No If no, what was the turnaround time? <br /> Approved by Signature Company Date <br /> I ' <br />