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❑ 680 Chesapeake Drive•Redwood City,CA 94 (415)364-9600 ❑ 18939 1201h Ave.,N.E.,Suite 1111 •Bothell,WA 911ul i •'ZUb'4n 1-Ei[uv <br /> ❑ 819 Striker Ave.,Suite 8+Sacramento,CA 95 0�J16)921-9600 ❑ East 11115 Montgomery,Suite B•Spokane,WA 99206 924-9200 <br /> UNOCAL 1 S.W.Sequoia Suite 110•Portland.OR 97222. 103)1124-9800 <br /> ❑ 404 N.Wiget Lane•Walnut Creek,CA 94598 (510)988-9600 ❑ 5055 Seq Pkwy, , <br /> Consultant Company: Project Name: 2��?QQ <br /> Address: 5. UNOCAL Project Manager: <br /> City: State: Zip Cade: 9� Z AFE;#: } <br /> C <br /> - y X09 <br /> Tele hone: .� FAX#: Site#, City, <br /> Report To: N. M vrzAf 4 Sam ler: QC Data: ❑ Level D(Standard) ❑ Level C ❑ Level B ❑ Level A c <br /> a <br /> Turnaround 1:110 Work Days ❑ 5 Work Days Work Days ❑ Drinking Water Anal ses Re nested <br /> Time: ❑ 2 Work Das ❑ 1 Work Day ❑ 2-8 Hours ❑ Waste Water <br /> CODE: ❑ Misc. ❑ Detect. ❑ Eval. ❑ Remed. ❑ Demol.❑ Closure ❑ Other <br /> Client Date/Time Matrix #of Cont. Laboratory <br /> Sample I.D. Sampled Desc. Cont. Type Sample# Comments <br /> ,.gyp 0 <br /> �� i � �� � = X X 0 <br /> L <br /> 3. (2, 4 <br /> 3 <br /> 4. D m <br /> } <br /> 5. <br /> 6. <br /> 7. <br /> 8. <br /> 9. Z' <br /> 0 <br /> 10, M <br /> 0 <br /> N <br /> Date: Timer30 Received B • Date:6 Time: <br /> Relinquished By: <br /> r- <br /> Relinquished By Dat Time: Received B : Date: Time: <br /> Relinquished B Date: Time: Received By Lab LDat2ekaTime: <br /> Were Samples Received in Good Condition?O Yes 0 No Samples on Ice? G Yes❑No Method of Shipment Page o{3 <br /> To-be competed upon receipt o report: <br /> 1) Were the analyses requested on the Chain of Custody repotted? ❑Yes U No If no,what analyses are still needed? <br /> rlaround time? ❑Yes 0 No If no,what was the turnaround time? <br /> 2) Was the report issued within the requested tur <br /> Approved by: Signature: Company: Date: <br />