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r ❑ 680 Chesapeake Drive•Redwood City,CA 94063•( 9600 U 18939 1201h Ave N E Suite 101 •Bothell WA 98011 •(206)4 00 u ` <br /> U O s .819 Stoker Ave,Suite 8•Sacramento,CA 95834•(91 1 21 9600 O East 11115 Montgomery Suite f3•Spokane WA 99206•(509) 00 <br /> O 404�} Wlget Lane•Weinut Creek,CA 94598•(510)988 9600 U 15055 S W Sequoia Pkwy,Suite 110•Portland OR 97222•(503)624 9800 <br /> Consultant Company &'e. f er - " IhC-„ Project Name (�y�o cz;L�� o 12-3 <br /> Address 31 LLI C�oO Dt`%ve St'iA4-- 2140 UNOCAL Project Manager N 1G K N ICI<erSo" <br /> City RG%-%CVa GrdOµa State CA Zip Code 91;6 70 AFE# c <br /> Telephone <br /> (9 166,31- 13aD FAX# (q16 9 31-131-7 Site#, City, State O l Z 3 c CA v <br /> c `` � <br /> reTo Dai v t C) Sam ler' v 16` 1`�zo OC Data f�Level D (Standard) ❑ Level C Q Level B ❑ Level A ct%ound bA 10 Work Days ❑ 5 Work Days 0 3 Work Days ❑ Drinking Water Anal ses Re uested I] 2 Work Das ❑ 1 Work Da ❑ 2-8 Hours ❑ Waste Water fl,1 \1 ,y01 <br /> CODE: U Misc ❑ Detect ❑ Eval ❑ Remed U Demol ❑ Closure ❑ Other �� �� �� h` <br /> Client Datef ime Matrix #of Cont Laboratory �a P`+ A ry' �� Comments <br /> Sample I D Sampled Dose Cont Type Sample# <br /> 1 U — 7 — 6 t1"r�-0 102 I �s C� —O S M I X CD 51�- <br /> 2 to -- -- 1 I 1x27 (A-'D) ° <br /> 3 (>- ?- l bca <br /> 1038 l -�� X X X X X t 1► Ore- <br /> C)- <br /> r2 J <br /> 4 U " - 21 I�s6 X X X X X X X <br /> 5 U -6 - 6 1303 <br /> 6 u-a^ II 130, rob X X X X X X <br /> 7 u- S - 16 1316 --01 X <br /> 8 0 -8- Z I 626 1 `0 X X X X X <br /> 9 5p_ I _ o f�Ws q —p X Q <br /> 0 <br /> 10 V1 <br /> 0 <br /> Date -IS Time / Received B Date j�5 Time L <br /> Relinquished ByM m <br /> �2 -- <br /> Relinquished By <br /> Date Time Received By Date Time <br /> Relinquished By I Date ITime lReceived By Lab Date Time <br /> 1 <br /> Were Samples Received to Good Condition'?U Yes❑No Samples on Ice? ❑Yes Ll No Method of Shipment Page of_ <br /> To be compete upon receipto report <br /> 1) Were the analyses requested on the Chain of Custody reported? U Yes 0 No If no, what analyses are still needed? <br /> 2) Was the report issued within the requested turnaround time? t_7 Yes U No If no, what was the turnaround time? __ _ __ _ _ <br /> Approved by _ _ __ _ Signature _ Company _ _ Date <br />