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' ❑ 680 Chesapeake Drive•Redwood City,CA 94015)364-9600 ❑ 18939120th Ave,N E,Suite 101 •Bothell,WA 98011 •( 81-9200 <br /> U A Q ❑ 8i9 Straker Ave,Suite 8•Sacramento,GA 95 (916)921-9600 ❑ last 11115 Montgomery,Suite B•Spokane,WA 99206•( 24-9200 <br /> ' ❑ 1900 Bates Ave,Suite LM•Concord,CA 94520•(510)686-9600 ❑ 15055 S W Sequoia Pkwy,Suite 110•Portland,OR 97222•(503)624-9800 ` <br /> Company Name V A/ all Project Name <br /> G� <br /> Address �j�� �Jr[� Z7G UNOCAL Project Manager � 1 57014 <br /> Ctty tIG4 Gy�(VZL. Statd Zip Code9G Release# .. <br /> Telephone q _ FAX# C"l 7�'3 —1- 7 Site# �p ' (07 < 11 T <br /> Report To 5(011 er l{�! QC Data LAKevel D(Standard) ❑ Level C ❑ Level B ❑ Level A <br /> Turnaround ":�'10 Work Days ❑ 5 Work Days ❑ 3 Work Days ❑ Drinking Water JAnalyses Requested -ri4 <br /> Time ❑ 2 Work Das ❑ 1 Work Da ❑ 2-8 Hours ❑ Waste Water 4 Y <br /> CODE: ❑ Misc,❑ Detect ❑ Eval ❑ Remed ❑ Demol ❑ Closure Other A 0 � 4 31 <br /> CS' <br /> Client Date/Time Matrix #of Cont Laboratory <br /> Sample I D Sampled Desc Cont Type Sample# Comments <br /> 2 2 <br /> co <br /> 3 <br /> 4 GV" c I o <br /> a) <br /> 5 IYW I 5 1- <br /> s A)--7 C <br /> 7 �} <br /> 8 w _Z l T <br /> 9 <br /> 10 r[ <br /> p <br /> Relinquished By Date Tim Received B r Date 12/1/42;7 Time 7:,3 0 `J <br /> a� <br /> Relinquished By Date , �� Time Received B a e <br /> Relinquished B a e Time Received B Lab'^ �- Date �+ Time <br /> Were Samples Received to Good Condition?❑Yes❑ No Samples on Ice? ❑Yes❑ No Method of Shipment Page of <br /> I <br /> Ta 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 /> oved by Signature Company Date <br />