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U&O C A LW <br /> J I I S Ave N! Saul It 101 •Boltiell *9206 <br /> 11 -(206)481 y4 c <br /> 819 Sinker Ave Suite 8•Sacrame�q 95834•{9t6J 921 9600 i� East i l 115 Montgomery Suite B•5pok�ne -(509)924� <br /> 1900 Bates Ave Suite i M•Concord GA 94520•(510)686 9600 Lt 15055 S W Sequoia Pkwy SWO 110•Portland OA 97222.(503)624 9804 <br /> Company Name z <br /> Protect Name Vic <br /> Address �L Lyrn <br /> UNOCAL Protect Manager <br /> tte 1 <br /> City <br /> Qct e <br /> t1 Zip Cade Release # <br /> Telephone Milo 6 FAX # 1 <br /> Site # ,cl/ i <br /> Re or!To �;L �1 �1 TSampler - <br /> S OC Data Levet D (Standard) I> Level C ❑ Level B I <br /> Turnaround f� 10 Work Days I' .5 Work Days ❑ 3 Work Day 1 J Level A c <br /> Time IJ 2 Work Das l� 1 Work Da I —r Drinking Water Anal ses Re uested ° <br /> _) 2 8 Hours I I Waste Water <br /> CODE. (_] Misc U Detect A.Eval ❑ Remed ❑ Demol ❑ Closure ❑ Other <br /> Client Date/Time Matrix <br /> Lh# of Cont LaboratoryDescSam le ! D Sampled <br /> Cont Type Sample# <br /> 2 � Comments <br /> '� <br /> 3 i <br /> r <br /> 4 <br /> 5 <br /> C <br /> 6 <br /> 7 <br /> 8 <br /> 9 <br /> 10 <br /> Z <br /> 0 <br /> c�a <br /> Relinquished By o <br /> Date�U ��,� Time!]Received <br /> Received B Date TimeRelinquished ByDale Time Received B Dale Time <br /> Relin uished BTlme B Lab �fS <br /> Were Samples Received to Good Conditions Date Time <br /> �S Yes U No Samples on Ice? Yes U No Method of Shipment <br /> Page)—of <br /> To be completed upon receipt of report <br /> 7 <br /> 1) Were the analyses requested on the Chain of Custody reported? U Yes U No If no, what analyses are still needed? <br /> 2) Was the report issued within the requested turnaround time? U Yes U No It no, what was the turnaround time? <br /> Approved by _ Signature - -- - --- I <br /> Company _ _ Date <br />