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rt r ❑680 Chesapeake Drive•Redwood City,CA 94063•(650)364-96 ❑18939 120th Ave,N E Suite 101 •Bothell,WA 98011 •(206)461- <br /> uN Oo&L El819 Striker Ave,Suite 6•Sacramento,CA 95834•(916)921-9600 ❑East 11115 Montgomery,Suite B•Spokane,WA 99206•(509)92W <br /> ❑404 N Wiget Lane•Walnut Creek,CA 94598•(925)988-9600 ❑15055 S W Sequoia Pkwy,Suite 110•Portland,OR 97222•(503)624-9800 <br /> ❑1455 McDowell Blvd North,Suite D•Petaluma,CA 94954•(707)792-1865 <br /> Consultant Company Ga^r, Rf w-3 lin e. JZ.S # Z,T'o Z cl S' Project Name Ao-.h,e', Und eQ) S-770- O/ <br /> Address " f::� Siarrxa (�oc-art Su;f f UNOCAL Project Manager /4 u� N►^ <br /> City bu 6![h State Zip Code QHS 6$ AFE # <br /> Telephone QL�-� s-�-1 �,�-,rte FAX # jt r��-r/�}��`g Site#, City, State �� -,(y-�, <br /> Report To „ Sampler s OC Data Level D (Standard) C3 Level C ❑ Level B © Level A <br /> U <br /> Analyses Requested L <br /> Turnaround �10 Work Days 5 Work Days ❑3 Work Days ❑Drinking Water Y q d <br /> Time ❑ 2 Work Days ❑ 1Work Day ❑2-8 Hours Waste Water <br /> COBE: ❑ Misc ❑ Detect ❑ Eval ❑Remed ❑ Demol ❑Closure Other <br /> Client Date/Time Matrix # of Cont LaboratoryComments <br /> Sample 1 D Sampled Desc Cont Type Sample # �� 1 <br /> 1 re <br /> O <br /> 2 U- 1 5 ! ' o <br /> 3 <br /> 3 <br /> 4 L1- 3 w 1 i0 <br /> 8 U. to:s 8 <br /> 10 as <br /> U q y l .'ri3' <br /> , r <br /> Relinquished By Date Time ,tfj Received By Date �� (� Time <br /> t <br /> Relinquished By Date Time Received By Date Time <br /> Relinquished By Date Time Received By Lab Date Time <br /> ' Were Samples Received in Good Condition? ❑Yes ❑ No Samples on Ice? ❑Yes O 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? ❑Yes ❑ No if no, what analyses are still needed9 <br /> 2)Was the report Issued within the requested turnaround time? ❑Yes 0 No If no, what was the turnaround time? <br /> Approved by Signature Company Date <br />