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r { X80 Chesapeake Drive•Redwood City,CA 94*15)364 9600 L] 18939 120th Ave N E,Suite 101 •Bothell,WA 98041 0)4819200 <br /> UCAL :1819 Striker Ave Suite 8•Sacramento,CA 95834•(916)921-9600 U East 11115 Montgomery Suite 6•Spokane WA 99206•(509)924 9260 <br /> D 1900 Bates Ave,Suite LM•Concord CA 94520•(510)686-9600 ❑ 15055 S W Sequoia Pkwy,Suite 410•Portland 4R 97222•(503)624 9800"' <br /> F "ti <br /> Company Name Project Name 1 l� ,f <br /> ,._ <br /> Address � 2, C UNOCAL Protect Manager' <br /> City l� r !; ( r State ' Zip Code Release# <br />� Telephone �%�, - � , <br /> r r� r FAX# f Site# <br /> Report To Sampler '~ �� r r OC Data -UF Level D (Standard) ❑ Level C ❑ Level B ❑ Level A <br /> Turnaround 4�)-10 Work Days ❑ 5 Work Days ❑ 3 Work Days ❑ Drinking Water JAnalyses Re nested a <br /> Time ❑ 2 Work Das ❑ 1 Work Day ❑ 2-8 Hours ❑ Waste Water <br /> CODE' ❑ Mlsc ❑ Detect ❑ Eval ❑ Remed ❑ Demol ❑ Closure ❑ Other <br /> Cient Date/Time Matrix #of Cont LaboratoryC' x <br /> Sample I D Sampled Desc Cont Type Sample# �� -1 Comments <br /> CU <br /> 1 ^�1 fy 11 1 j i, ,r f r r' i ! '` e I� I O <br /> 2 <br /> Q <br /> Cz <br /> 3 <br /> 4 a <br /> 5 } <br /> 6 <br /> 7 <br /> B <br /> 9 <br /> 110 <br /> ca <br /> Relinquished By Date' Time ` : Received By -' Date Time J <br /> - _ m <br /> Relinquished By J Date Time Received B -- Dafe Time <br /> Relinquished B -- Date Time Received By Lab r r <br /> ~-- -- Date Time <br /> Were Samples Received in Good Condition?0 Yes❑ No Samples on Ice? ❑Yes a 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? ❑Yes❑ No If no, what analyses are still needed? <br /> 2) Was the report issued within the requested turnaround time? ❑Yes❑ No It no, what was the turnaround time? <br /> Approved by Signature Company Date <br />