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U bbU GnesapeaKe urrve•hWUVVUUU.Iky �^ a1 Jf 11_1 — - - <br /> U 819 Striker Ave,Suite 8•Sacramento,CA 9 •(916)921 9644 U East 11115 Montgomery,Suite B•Spokane WA 99246 )924 9240 <br /> UN AL <br /> U 1900 Bates Ave,Suite t M•Concord CA 94520•(514)686-9600 :115455 5 W Sequoia Pkwy,Suite 110•Portland,OR 97222•(503)624 9800-- <br /> r <br /> Company Name S Project Nan,e <br /> Address ��,7 7 �i C Sc 7 ��� 1p(� i-11 C UNOCAL Project anager1/E [�RriL f <br /> City J cis c State C 1' Zip Code Release# c <br /> Telephone '1 r t� FAX# Site# <br /> j / - OC Data evel D (Standard) ❑ Level C ❑ Level B ❑ Level A � <br /> Re art To `cL v 5 5 JSampler !4 C� 1 E <br /> Turnaround >(iD Work Day&4#5 Work Days ❑ 3 Work Days ❑ Drinking Water lAnalyses Re uested <br /> Time ❑ 2 Work Das ❑ 1 Work Da 1:12-8 Hours ❑ Waste Water <br /> CODE- ❑ Misc ❑ Detect ❑ Bval O�Remed ❑ Demol ❑ Closure ❑ Other <br /> Client Datef ime Matrix #of Cont Laboratory <br /> Comments <br /> Sample 1 D Sampled Desc Cont Type Sample# <br /> 1 L, 20 <br /> 2 Ll <br /> 3 0 <br /> 4 � <br /> r <br /> 5 <br /> 6 <br /> 7 <br /> 8 <br /> 9 <br /> 10 0 <br /> Relinquished By _ - �� Date �� 1 > Timer �r Received B <br /> Date / 1 f Time <br /> Relinquished By <br /> Date iL Jz1 r� <br /> Time/5�D Received B cut.E'y Date �z�� Time —5 <br /> Relinquished 8 p Date 2 /L wTime G Vz) I Received '' b I D�atte!� Time <br /> Were Samples Rec ed in G d Condition? i es IJ No Samples on Ice? U Yes two Method of ipment F' ��✓t Page —of <br /> To be completed upon receipt of report <br /> )) 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? 01 Yes U No If no,what was the turnaround time? <br /> Approved by —�__ __ -Signature __ ---___------- -_- Company _-- -- -- _-_—�---Date _ <br />