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1J680 Chesapeake Drive•Redwood City CA 9406 15)364 9600 1-1 18939 120th Ave N E Suite 101 •Bothell WA 96011 •( 81 9200 <br /> UNAL (D <br /> U 8 19 Striker Ave Suite 8•Sacramento,CA 958346)921 9600 1-1. East 11115 Montgomery Suite B•Spokane WA 99, • 1,024 9200" <br /> IJ 404 N Wiget Lane•Walnut Creek CA 94598•(510)988 9600 U 15055 S W Sequoia Pkwy,Suite 110•Portland OR 97222•(503)624-9800 <br /> Consultant Company � .� -. _ _� t�C Protect Name Zqf H i,,(,-;t'' kx-m, e <br /> Address 6 zI ��o�z CLQ ��.� `,t ��✓ �, UNOCAL Project Manager <br /> City t �ti� �,,a ��,�-�, �� State CiA Zip Code 95-670 AFE# <br /> c <br /> l � <br /> Telephone CLI t- (3 UZ) FAX # (U tau 6-3-t - () 1 7 Site #, City, State U 9-7 'S <br /> Re ort To R vfcfc JSarnpl r �� +C� � ef cr QC Data 1.I Level D (Standard) U Level C lJ Level B U Level A <br /> cf <br /> Turnaround >(10 Work Days I] 5 Work Days 1:13 Work Days tJ Drinking Water Analyses Requested <br /> Time lJ 2 Work Das Irl 1 Work Day iJ 2-8 Hours fJ Waste Water <br /> CODE IJ Misc I_.l Detect U Eva1 1J Remed ❑ Demot ❑ Closure U Other <br /> Client Date/Time Matrix # of Cant Laboratory <br /> Sample I D Sampled Desc Cont Type Sample# ��� ,t Comments <br /> I n <br /> r,S <br /> <r 1 <br /> 2 <br /> CIS3 <br /> 4 0 <br /> a� <br /> 5 �- <br /> 6 <br /> 7 <br /> 8 <br /> 9 <br /> 10 a <br /> co <br /> • o <br /> Relinquished By ` l Date S - I-07) Time Received By if Date S /< [f Time <br /> c � <br /> Relinquished By f', Date 5--// cj6� Time IbVt) Received B — Date T++x1e G'vim. <br /> 1 <br /> Relin(wishedBy I Date ITime I Received By Lab I Date ITime <br /> Were Samples Received in Good Condition?/1Y <br /> ondition?I Yes L1 No Samples on Ice?4Yes IJ No Method of Shipment C`'(f%�[ �,/ _ Page_of <br /> So be completed Uponreceipt of report <br /> 1) Were [tie analyses regUested on the Chain of Custody repotted? 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 Na If no, what was the turnaround time? <br /> Approved by Signature Company Date <br />