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180 Chesapeake Drive•Redwood City,CA •(415)364-9600 ❑ 18939120th Ave,N E,Suite 101 •Bothell,WA 9801 )481-9200 <br /> ❑ 819 Striker Ave,Suite 8•Sacramento,{',A34•(916)921-9600 ❑ East 11115 Montgomery,Suite B•Spokane,WA 99206. 509)924-9200 <br /> � <br /> UACAL' (D <br /> D 1900 Sates Ave,Suite LM•Concord,CA 94520•(510)686-9600 ❑ 15055 S W Sequoia Pkwy,Suite 110•Portland,OR 97222•(503)6249800 <br /> Company Name C��D 'r f.15. �n G t_. - 9,411, Y me S��rr 2101 <br /> Address 31� �1 6m �r-? ��1 UNOCAL Protect Manager C cf� L "l 'L-( <br /> City Q i2GJ16' /�-'rc)�tate (� Zip Code Release# �j ( 7 7 '36 <br /> Telephone �'' ! — 3/�l 3�� FAX# ��i1� r'�1 ��f Site# C 5/ 1 V 2] �Cf/'I c, ST �7C"I G0 v <br /> Report To iSampler �`�r L-� 4-<_ QC Data IrLevel D(Standard) ❑ Level C ❑ Level B ❑ Level A <br /> Turnaround 4kliko Work Days ❑ 5 Work Days 3 Work Days ❑ Drinking Water Anai ses Re uested ��� 603 . a <br /> Time. lJ 2 Work Das ❑ 1 Work Da ❑ 2-8 Hours ❑ Was Water <br /> h <br /> CODE: ❑ Misc ❑ Detect ❑ 1~val teemed ❑ Demol ❑ Closure Other a: <br /> Client Datefrime Matrix #of Cont Laboratory <br /> Sample I D Sampled Desc Cont Type Sample# Comments <br /> 1 7 � 97 7Av- <br /> 15 <br /> 2 IJ-1] 4., /3 Z 0 <br /> ca3 <br /> � 3 <br /> 4 <br /> } <br /> 5 <br /> 6 <br /> 7 <br /> I I <br /> 0 <br /> 10 io <br /> 0 <br /> �/ M <br /> Relinquished By e Date Time 6 Received B / 47-� Date Time <br /> a) <br /> Relinquished By Ci.J�'` Date K11(1Q) Time Receive Date Time <br /> Relinquished B Dat 45 / Time Received By Lab �- Date -r q1 Time S <br /> Were Samples Received in ood Condition? ,T G'❑No Samples on Ice? ❑Yes es Method of Shipment Page of <br /> I <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 If no,what was the turnaround time? <br /> Approved by Signature Company Date <br />