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0 680 Chesapeake Dnv8•Redwood City CA 940 •(415)364 9600 U 18939 120th Ave N E,Suite 101 •Bothell,WA 98011 •0 481-9200 <br /> 0 819 Striker Ave Suite 8•Sacramento,CA 95834•(916)921-9600 Q East 11115 Montgomery Suite B•Spokane,WA 99206•(509)924 9200 '} <br /> UNDERL00 1900 Bates Ave,Suite LM•Concord,CA 94520•(510)686 9500 Q 15055 S W Sequoia Pkwy,Suite 110•Pordand,OR 97222•(503)624 9800 V <br /> Company Name ��- Project Name ��, h <br /> � ► <br /> Address > �' �, / '! • a UNOCAL Project Manager i �,i (� ; '✓� <br /> �r <br /> City �- „ , State zip Code Release # <br /> Telephone ��(< , ,,?1 � FAX # Site # c ��' �`}tili ]�1,� I �C)�J CU <br /> Report To { �' QC Data ❑ Level A (Standard) ❑ Level B ❑ Level C ❑ Level D <br />� a- <br /> Turnaround ❑ 0 Working Days _❑ 2 Working Days Q Drinking Water JAnalyses Requested <br /> Time ❑ 5 Working Days ❑ 24 Hours ❑ Waste Water :1"Al <br /> ❑ 3 Working Days ❑ 2 -8 Hours ❑ Other <br /> Client Date/Time Matrix #of Cont Laboratory <br /> Sample I D Sampled Desc Cont Type Sample # f 1` / Comments <br /> o <br /> co <br /> I l �. I _ r C12- <br /> -72 O 0 <br /> J <br /> 3 <br /> 4 - <br /> a� <br /> 5 <br /> 6 <br /> 7 <br /> 8 <br /> 0 <br /> 10 cs <br /> Received B ---- Date — -- -- Time J <br /> Relinquished By _ _ / + _ - Date 5 / Time „ , , <br /> Relinquished By - Date Time Received By Date ` - Times <br /> Relinquished By Date Time Received By Lab �- -~ ---- - Date '��y Time r G c>O <br /> I <br /> Were Samples Received in Good Condition?JD Yes❑ No Samples on Ice? 0 Yes 0 No Method of Shipment Page of <br /> To be competed upon receipt of report <br /> 1) Were the analyses requested on the Chain of Custody reported? ❑Yes 0 No If no, what analyses are still needed? <br /> 2) Was the report issued within the requested turnaround time? 0 Yes 0 No if no, what was the turnaround time'? <br /> Approved by Signature Company Date <br />