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" �'�""",•"Y "' 415 364-9600 U 18939 1201h Aye.N E.Sadie lot-Bonielk WA 98011• 481-9200 <br /> U �I CAL ❑ 819 Sluices Ave.Suite 8 Secramema-CA -(9 16)921-9500 U East 11115 hto <br /> 1900 Bales Ave,5ur6e tEi-CartCord GA ��e�l.Sale B•Spokane.WA 99206. 924-92Q0 <br /> 94520-(510)6a6-9600 © 15©55&W Segtjosa Pkvry,Suite 110-PadWA on 97222.(503)6241-MM <br /> OnIpany Marne- - <br /> Address �Ir - Project Narrte �l70'7 $1 Ac [,c.t` Jr/r � <br /> !G � UNOCAL Project Manager <br /> City: Lf e�C (/ JcvaState. �} q�� 7 ['�,�ivl <br /> Zip Code��i 7G Release# <br /> e[ephone / �/ 1 m <br /> FAX <br /> f ��- � # (;-3/-/.S`/`-7s [-4 �# <br /> its� <br /> Re rt Ta_ y. � Sam r ��i! CL1 <br /> `�� CC Data. vel D(starccfard) ❑ Leve!C ❑Levet B ❑ Level A •�� <br /> Turnaround Work Days ❑5 Work Days ❑3 Worts Da za <br /> Time � 0 Drinking Water [Analyses R uestec# 11(0 <br /> ❑21liJork Das C� I Work Da 13 2-8 Hours M <br /> ❑ Waste Water D <br /> CODE;❑Misc ❑ Detect ❑ Eval. ❑ Reined ChDel l ElClasure C1Olher �� c <br /> 0 <br /> Crient Date/time Matrix #of CoatLab '3) <br /> Sample I D Sampled Desc Cont T e oratory z <br /> Yp Sample# Comments r1'- <br /> 1 1 6 <br /> r v <br /> .n <br /> 4. `ar <br /> I <br /> S y <br /> 0 <br /> 6 � <br /> 7. <br /> s <br /> 9 <br /> 10 <br /> El- <br /> 0 <br /> m <br /> ReljAquished By- o <br /> Time - Recenred B <br /> Date <br /> Relinquished By Datem <br /> Trine Date, <br /> Relrn vished By �/ � <br /> a e Trine Received B Lab t7 <br /> Were Samples Received in Good Condition Date Ti1ne� <br /> L]Yes L!No -c <br /> Samples on Ice? ❑Yes❑No F�1Ethod f Shr ens <br /> To be completed upon receipt of report Page—of_ Z. <br /> 1) Were ltle anajyses requested on the Chain of Custody report ol'? Yes Q NO if ria,what arta _ <br /> 2) Was the report issued wth- 1t1 requested[urnaround tune? ��are stilt needed? <br /> . I by No If hat was isle iumaround 1 me? <br /> -- - - - - - - Signature -- - - Company- --- _���_^_ Date- <br /> y ll 6 <br /> _—.. <br />