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❑ 680 Chesapeake Drive-Redwood City,CA 94063-(415)364 9600 ❑ 16939 120th Ave,N E,Suite 101 -Bothell,WA 96011 -(206)461 9200 <br /> UNOCRL (D <br /> C) 819 Striker Ave,Suite 8-Sacramento,CA 95834-(916)921-9600 ❑ East 11115 Montgomery,Suite B-Spokane,WA 99206-(509)924 9200 <br /> �k 1900 Bates Ave,Suite LM-Concord,CA 94520-(510)686 9600 Q 15055 S W Sequoia Pkwy,Suite 110-Portland,OR 97222-(503)624-9800 <br /> C <br /> Company Name any \\y���\�� \L Project Name <br /> Address �� �,Z �y��� �ft'\yt �ti,��'� '�` UNOCAL Project Manager <br /> City QSA-x( ) State �� Zip Code Release Release # <br /> C <br /> � �V ���-��� FAX # � ���Z site # <br /> LRe <br /> phone <br /> ort To <br /> Sam ler OC Dataevel A (Standard) ❑ Level B ❑ Level C ❑ Level D c <br /> 0- <br /> Turnaround 10 Working Days ❑ 2 Working Days ❑ Drinking Water JAnalyses Requested <br /> Time ❑ 5 Working Days 1:124 Hours ❑ Waste Water <br /> 1:13 Working Days ❑ 2 - S Hours '4 Other <br /> Client Date/Time Matrix # of Cont Laboratory <br /> Comments <br /> Sample I D Sampled Desc Cont Type Sample # �` L4 <br /> 2 ('1117(11170C, <br /> s .�,�s <br /> 5 <br /> 40'7n710 <br /> s � � 0792 2 <br /> 9 407n'7113 <br /> z <br /> 10 n 14 <br /> Relinquished By e\ Dated 13 f�-( Time RecerV d Date Time <br /> Relinquished By Date Time Received By_ Date Time <br /> Relinquished B Date Time ReceivedLl ab Cf C� Date Time �3 3 <br /> Were Samples Received in Good Condition?xYes Q No Samples on Ice?XYes 0 No Method of Shipment Paget of <br /> To be completed upon receipt of report <br /> 1) Were the analyses requested on the Chain of Custody reported? ❑Yes 11 No If no, what analyses are still needed? <br /> 2) Was the report issued within the requested turnaround time? 0 Yes❑ No If no, what was the turnaround time? <br /> Approv Signature Company D to <br />