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I ' if 1i <br /> ❑680 Chesapeake Drive•Redwood City,CA 94063 (650)364 9600 018939120th Ave,N E Suite 101 •Bothell,WA 98011 •(206)481-9200 <br /> UNOCAL ❑819 Striker Ave,Suite 8•Sacramento,CA 95834•(916)921-9600 ❑East 11115 Montgomery,Suite B•Spokane,WA 99206•(509)924-9200 El 404 N Wiget Lane•Walnut Creek,CA 94598•(925)888-9600 � 15055 S W Sequoia Pkwy,Suite 110•Portland,OR 97222•(503)624-9800 <br /> % 0 1455 McDowell Blvd North,Suite D•Petaluma,�� 954•(707)792-18 <br /> CA 9465 <br /> L-A Ir <br /> ti ; <br /> Consultant Company e, f— � �,�nG o7c� -�,U Project Name �dr � lei+ oCa <br /> Address ( ,L -�'l�,rrq Gcrw,�-7f UNOCAL_ Project Manager Mt �a <br /> r <br /> City State Gam, _ - Zip Code9,1'q ,�> AFE # <br /> Telephone>�c L����1 �'�S-� FAX kyL� "�j � Site #, Clty, State s'6a6 ��e.~ ;c. ?e. `sni C r <br /> F U <br /> ReportTo.Dea,y��. a�'r�t.� Sampler Level D (Standard) ❑ Level C ❑ Level B ❑ Leval A <br /> Turnaround 10 Work Days ❑5 Work Days z CL <br /> ❑3 Work Days O Drinking Water Analyses Requested <br /> Time- �j 2 Work Days O 1 Work Day El2 8 Hours Waste Water4 J,r <br /> CODE: ❑Mise ❑ Detect ❑ Eval tRemed ❑ Demo[ 0 Closure El ether <br /> Client Date/Time Matrix # of Cont Laboratory ��� Comments <br /> Sample I D Sampled Desc Cont Type Sample # - <br /> zvO L V�t��n � � � 0 - <br /> !L / 6 1'r o <br /> 71 <br /> 3 µ , <br /> 5 MW 2I5 G%Ai#6 MW 20 <br /> X _ <br /> i II <br /> e 2: - <br /> I!�r <br /> x - 1 - x O <br /> 10 a -- »" ' m - <br /> ?'- ry Y II �f-- Received B _x,1,(/,1-Gt 1� if ate ��/3 �I JTtme <br /> Relinquished By Date , ; Time -� Y <br /> Relinquished By Date ; Time Received By r _ Date 'Time <br /> Time Received B Lab Date Time <br /> Relinquished ' <br /> Relinquished By Date ;, Y <br /> 7 <br /> Were Samples Received in Good Condition? -❑Yes ElNo Samples on Ice? ❑Yes j ❑No Method of Shipment - Page 1 of� <br /> To be completed upon receipt of report <br /> 1)Were the analyses requested on the Chain of Custodylreported? O Yes 0 No If,no, what analyses are still needed? <br /> 2)Was the report issued within the requested turnaround,itim I' ❑Yes ❑ No If no, what was the turnaround time? <br /> A roved b Y Signature Company Dat <br /> PP <br />