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ID680 Chesapeake Drive•Redwood City,CA 940924-9200 (415)364 9600 El 120th Ave,Ave,N E,Suite 101 •Bothell,WA 98071 • 481 9200 U C`A L ❑ 819 Striker Ave,Suite 8•Sacramento,CA 9 •(916)921-9600 ❑ East 11115 Montgomery,Suite B•Spokane,WA 992D6 • ❑ 1900 Bates Ave,Suite LM•Concord,CA 94520•(510)686 9600 ❑ 15055 S W Sequoia Pkwy,Suite 110•Portland,OR 97222•(503)624 9800 Company Name p'i fry��-� //r;,U Protect Name V 7PGt_ Address _�� `' ��+ �� Y' i ,-, 7`„ r= �` g /� UNOCAL Project Mana ger , City mel-In r j , �, , �:�z�: State l % zip Code`��s ,'.f Release# - Telephone �� FAX# ' - 1 ,�r� ! � , ,. -- Site# �v Report To t c Y 'f v- --]Sampler i� ' `' �{ OC Data -@ Level D(Standard) ❑ Level C ❑ Level B ❑ Level A Turnaround ❑ 10 Work Das 5 Work Das ❑ 3 Work Das _ d Y � Y Y ❑ Drinking Water Ana! ses Requested _ Time ❑ 2 Work Das ❑ 1 Work Da ❑ 2-8 Hours ❑ Waste Water tV ��j - 1 r CODE. ❑ Mise ❑ Detect ❑ Eval b Remed ❑ Demol ❑ Closure ❑ Other �— Client Date/Time Matrix #of Cont Laboratory Sample I D Sampled Desc Cant Type Sample# ' Comments i 7r� � I 13 C ' X ° c� J 3 4 0 I � 5 } 6 7 8 9 0 10 ro a Relinquished By ��`. ��/�rf� Date -17/4L, Time 0 � Received B { i ,��, i }'1 Date Gl Time �� f J co ' , r' r !f�- 9 i w,' � a Date-, �{�F l Time - - Relinquished sy��.� �. -. ,� ► Date (�, )i� Time --,. � Received B ,- � l r17 Relin uished B 4, —//17Dath Time, Received By Lab -��=� Date �- ' 'Time ,r Were Samples Received in Good Coalition?0 Yes❑ No Samples on Ice? ❑Yes 0 No Method of Shipment Page j of To be completed upon receipt of report ay 1) Were the analyses requested on the Chain of Custody reported? ❑Yes❑ No If no, what analyses are still needed? 2) Was the report issued within the requested turnaround time? 0 Yes❑ No If no, what was the turnaround time? � Approved by Signature Company Date t