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U68 Chesapeake Drive•R ' <br /> ❑819 Striker Ave,Suite 8•Sacramento,CA 85834• 921-9600 ❑ East 11115 Montgomery,Suite B•Spokane,WA 89208'{50 9200 . <br /> UNo AL • <br /> `` ❑ 404 N Wiget Lane•Walnut Creek,CA 94598•(510}988-9600 ❑ 15055 S W Sequoia Pkwy,Suite 110•Portland,OR 97222•( 4-9800 <br /> I � <br /> Consultant Company &444, Day -the— e�d� 2"3'Z)o C ProlectName 606 dC4 ss S"v <br /> Address. 6 ST CI'1� UNOCAI<I'rofectManager Mr �a R6 us 7� <br /> City b AState C Q • Zip Code �S'Ea S AFE# <br /> LD <br /> Tele hone �� S-S-/, FAX s=/,-7�qy Site#, City,State &Q6 "~c- t• S �k�oh v <br /> ��/� - OC Data Level D Standard ❑ Level C ❑ Level B ❑ Level A c <br /> Re ort To Dean �,. carol+-n�—ISampler a <br /> Turnaround 10 Work Days ❑ 5 Work Days ❑ 3 Work Days ❑ Dnnking Water Anal ses Requested <br /> Tlme: ❑ 2 Work Das ❑ 1 Work Da ❑ 2-8 Hours )a Waste Water . <br /> CODE: ❑ Misc ❑ Detect. ❑ Eval ❑ Remed ❑ Demol ❑ Closure ❑ Other <br /> Client Date/Time Matrix #of Cont Laboratory �� <br /> Comments <br /> j Sample I D Sampled Desc Cont Type Sample# Z' <br /> .110 <br /> 4 Z,1 �QD 4t, +H Z 'c <br /> FhW- Tib S S ;c Z ~ <br /> 6 -El <br /> I V 7 0W,Z2S k b`� Z 4 <br /> k <br /> 9 0 <br /> 10 <br /> {1;� <br /> Relinquished By Aig Date -Received B Date Time l <br /> Relinquished By _ Date Time Received B <br /> Date' Time- <br /> Relinquished <br /> Relinquished By Date jy1me I Received By Lab' Da <br /> Were Samples Received in Good Condition?O Yes❑No Samples on Ice? ❑Yes 4 No Method of Shipment Page—of— <br /> o be completed upon receipt o report. <br /> 1) Were the analyses requested on the Chain of Custody reported? ❑Yes D No If no,what analyses are still needed? <br /> 2) Was the report issued within the requested turnaround time? ❑Yes O No If no,what was the turnaround time? <br /> Com an Date- <br /> Approved by Signature P Y <br />