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U 680 Chesapeake Dove•Redwood City,CA 94015)364 9600 U 18939 120th Ave,N E,Suite 101 •Bothell,WA 98011 •( 481 92ob r <br /> 34 i6)921-9600 O East i 1115 Montgomery,Suite B•Spokane,WA 99206. 924-9 <br /> UN �, t30�. <br /> AL • C1 819 StrikerAve Ave,,Suite 8•Sacramento,CA 958 <br /> ❑ 4D4 N Wiget Lane•Walnut Creek,CA 94598•(51(3)988-9600 U 15055 S W Sequoia Pkwy,Suite 110•Portland,OR 9222•(503)624-9800} <br /> ori <br /> 08 <br /> Consultant Company Com- ETT L L a Project Name Fo R� �,� uN QCf}L <br /> Address 4-1 .j k, Q707,0J, C .T UNOCAL Project Manager 13 013 U <br /> City 12 ill B k— /U State Zip Code 1�}-��p$ AFE# d� Stoc V--4o 1) .. <br /> y �_ a � r c <br /> Telephone 02�13)5'5-1 -75555- FAX 9 rite#, City, State �!" CI v y �� do <br /> Report To PE4NN4 WP) am ler Va P-rK&-S 140 oC Data Level D (Standard) ❑ Level C ❑ Level B ❑ Level A c <br /> EL <br /> Turnaround K10 Work Days ❑ 5 Work Days ❑ 3 Work Days ❑ Drinking Water JAnalyses Requested! <br /> Time: ❑ 2 Work Das ❑ 1 Work Day ❑ 2-8 Hours1li <br /> L1 Waste Water � <br /> CODE: ❑ Misc ❑ Detect ❑ Eval ❑ Remed ❑ Demol ❑ Closure t40lher / 1 <br /> Client DatelTtme Matrix # of Cant Laboratory <br /> Sample I D Sampled Desc Cont Type Sample# 1 Comments <br /> 'TB — �1 o <br /> 2 U p $ ca <br /> 3 Ik— JOQ ,I <br /> 4 U <br /> 5 U <br /> 6 U,_ r �� <br /> v I/ <br /> 8U- v <br /> 9 2' <br /> 0 <br /> cc <br /> 10 <br /> 0 <br /> .0 <br /> m <br /> Relinquished By ate Time Received B 22g,k Date G Time <br /> m <br /> Relinquished By <br /> Date ' L//;r' Tim , ' Received B Date Time <br /> Relinquished By I Date ITime lReceived By Lab Date to g1 ime <br /> Were Samples Received in Good Condition')XYes❑No Samples on Ice? KYes❑ No Method of Shipment Page_of <br /> To be competed upon receipt of report <br /> 1) Were the analyses requested on the Cham of Custody reported? Lt Yes Lt 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 /> Approved by - �- _ _-- - _-_ -- Signature _--_ _ -- -- Company _ Date <br />