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/680 Chesapeake Drive•Redwood City,CA 940 15)364 9600 ❑ 18939 120th Ave,N E.Suite 101 •Bothell,WA 98011 •( 1-9200 a <br /> ❑ 819 Striker Ave,Suite 8•Sacramento,CA 95834•(916)921-9600 ❑ East 11115 Montgomery,Suite B•Spokane,WA 99206•(5 924 9200 <br /> 31 UN AL <br /> ❑ 1900 Bates Ave,Suite LM•Concord,CA 94520•(510)686-9600 Q 15055 S W Sequoia Pkwy,Suite 110•Portland,OR 97222•(503)624-98W <br /> "y Company Name flyia� 5/k f ,f J Protect Name ,y7GI 'r/,L, _ <br /> Address u� UNOCAL Project Manager <br /> City i ! � r State �"�� Zip Code j=tr ['1 Release# <br /> Telephone , ` r_ C,-s/ ,: FAX# f �� Site# <br /> U <br /> f <br /> Re ort To iSampler C_ QC Data JQ'Level D(Standard) ❑ Level C ❑ Level B ❑ Level A c <br /> Turnaround 'f0 Work Da . <br /> Ys ❑ 5 Work DaYs ❑ 3 Work Days 1:3h� T Drinking Water Anal ses Requested � <br /> Time ❑ 2 Work Das 1:11 Work Da ❑ 2-8 Hours ❑ Waste Water <br /> CODE ❑ Misc ❑ Detect ❑ Eval 0 kemed ❑ Demol ❑ Closure ❑ Other ,Q <br /> Client Date/Time Matrix #of Cont Laboratory Comments <br /> Sample I D Sampled Desc Cont Type Sample# <br /> 75 <br /> 3 <br /> 3 <br /> 4 2 <br /> 5 <br /> 6 <br /> 7 <br /> 8 <br /> 9 <br /> 0 <br /> 10 co <br /> 0 <br /> Relinquished By �-- C�'L __ Date)!'" Time Received B —' - Date-f�Time J <br /> a� <br /> Relinquished By Date �` Time-- Received B - Date"'~-_Time <br /> Relinquished B = Date' _ Time-` Received B Lab �` N -.�f f�f` � Date Time / <br /> Were Samples Received in Good Condition?❑Yes a No Samples on Ice? ❑Yes❑ 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? IJ Yes ID No If no,what analyses are still needed? <br /> 2) Was the report issued within the requested turnaround time? a Yes❑ No If no,what was the turnaround time? <br /> Approved by Signature Company Date <br /> r <br />