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0680 Chesapeake Drive•Redwood City,CA 94063•(650)364-96 O 18939 120th Ave,N E Suite 101 •Bothell,WA 98011 •(206)481-i <br /> UNOCAL O 819 Striker Ave,Suite 8•Sacramento,CA 95834•(916)921-9600 O East 11115 Montgomery,Suite B•Spokane,WA 99206•(509)9243L00 <br /> Cl 404 N Wiget Lane•Walnut Creek,CA 94598•(925)988-9600 O 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 G4f#r_ /e a.� ��G. ?,ftd YS- Project Name <br /> Address 67444 9tc&/--4 ( c�-+r7� sem% UNOCAL Project Manager 14r-. av 64 Alj�.crd» <br /> City Z)U- StateCAR <br /> Zip Code C��.s--6 g AFE # <br /> Telephone �*y�-�s�-� SSSS FAX # �ssry� � Site #, City, State F�/-A►ir " fAc'&A <br /> Report To egzn n [ Sampler � DC Data Level D (Standard) ❑ Level C ❑ Level B ❑ Leve! A Y <br /> Anal Requested S <br /> Turnaround 1 10 Work Days 5 Work Days Elses 3 Work Days ❑Drinking Water Y q tL <br /> Time 2 Work Days ❑ 1 Work Day ❑2-8 Hours �11 Waste Water � fl <br /> CODE: ❑Misc O Detect ❑Eval ❑ Remed ❑Demol ❑Closure ❑Other �, V <br /> Client Date/Time Matrix # of Cont Laboratory Comments <br /> Sample I D Sampled Desc Cont Type Sample # <br /> 1 UZD S / ;Ni s U'dfj j0S-f`1< <br /> 2 G � Zf <br /> 3 Z2 t -aP �- •c- <br /> ti u 3 <br /> 4 _ z3 r8.•�r� .� s- X ° <br /> 6 U Z-S'- 5, <br /> 7 <br /> 8 <br /> 0 <br /> 9 <br /> 0 <br /> 110 <br /> , <br /> Relinquished By Date Time 19,VS" Received By at r Tlme <br /> r <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 ❑No Method of Shipment Page T of _ <br /> To be completed upon receipt of report <br /> 1) Were the analyses requested on the Chain of Custody reported? 0Yes ❑ No If no, what analyses are still needed? <br /> 2)Was the report issued within the requested turnaround tlme'7 ❑Yes ❑ No If no, what was the turnaround time'? <br /> Approved by Signature Company Date <br />