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E9JN7PLMCI6elN&ape1ive•Mod CM 940 <br /> 0) 0 M M39 1�e, I+_ite 1t thel1J9011=) M _ <br /> O 819 Straker Ave, Suite B•Sacramento CA 95834 9 0 LJ East 11115 Montgomery,Suite t3•Spokane,WA 99206•(54 9200 <br /> C1404 N Wiget Lane•Walnut Creek,CA 94598•(925)988-960 ❑15055 S W Sequoia Pkwy,Suite 110•Portland,OR 97222•(503)624-9800 <br /> tr 3 ❑1455 McDowell Blvd North,Suite D•Petaluma,CA 94954•(707)792 1865 raL0Bk[ ;'Pj# T06 770-fl')08 <br /> Consultant Company ";,eulor.-Ryan Ilic. Project Name Fomer U=0ca1 #'509P & tfont risme -v War4s <br /> Address 6/47 'OLerra court:, St; t".e UNOCAL Project Manager Nick Nicl!s.e-son 916- 71A-3205 � <br /> City Dub I3rx State C� Zip Code945;0 AFB # <br /> Telephone `t7a�55A�7` �x5 FAX # 925-351 76q Site #, City, State 5098 5400 & 56,06 Paci-fic Ave.. SLockt'o-�I. (A <br /> Report To 11-an;, L. Ha-, cO i n Sampler f/ f � ,. ❑C Data 0 Level D (Standard) ❑ Level C El B ❑ Level A v <br /> a <br /> Turnarounclc <br /> ifl Work Days ❑5 Work Days ❑3 Work Days ❑ Drinking Water Analyses Requested <br /> Time ❑ 2 Work Days ❑ 1 Work Day El 2-8 Hours d Waste Water (L <br /> CODE- ❑Misc ❑ Detect 0 Eval O Remed ❑ Demol ❑Closure ❑Other <br /> Client Date/Time Matrix # of Cont Laboratory <br /> Sample I D Sampled Desc Cont Type Sample # y`' Comments <br /> a�,,s ll:c•a�r-ttr all i'nakn <br /> ( � F" f C a� i f�. „F •'tee Y�.}j7 y F` r" for 8260 n511 Srr'mi d <br /> I>Y <br /> cd <br /> 3 TBAYDIPE ETBE J <br /> 4 ;io _ , r! S TAME 1,'DCA, o <br /> e EDB <br /> El f4�E f +% 6d+ s° !? � cP r `�` <br /> 7 s <br /> �r <br /> 9 t Imo, ` ,*r<,d /# s" �- o <br /> M <br /> Relinquished By i; , , Date , Time ;�� Received By Date -� tf1� Time �? j� m <br /> ` L <br /> Relinquished By Date Time Received By Date Time <br /> Relinquished By Date Time Received By Lab Date Time <br /> Were Samples Received in Good Condition? ❑Yes ❑No Samples on Ice? ❑Yes ❑No Method of Shipment Page of <br /> To be completed upon receipt of report <br /> 1)Were the analyses requested on the Chain of Custody reported? ❑Yes ❑ 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 0 Signature Company Date <br />