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❑ 680 Chesapeake Drive•Redwood City,CA 94063•(415)364-9600 C1 18939120th Ave,N E.Suds 101 •Oji,"' um'r•tam)—1-OOL— <br /> 921-9600 O Fast 11115 Montgomery,Suite B•Spokane,WA m('(SM)M)924-920D <br /> ■ 819 Straker Ave,Suite 8•Sacramento,CA 95634•(916) <br /> • <br /> El1goo Bates Ave,Suite LM•Concord.CA 94520•(510)686-9600 ❑ 15055 S W SDI".5ude 110.porl{arnd,OR 97222•(503}62 <br /> UNOCAL <br /> Project Name �rYJI' J,1 ;L <br /> Company Name G8 .,. �1/ ANG <br /> 3 � Ca� UNOCAL Project Manager jG ke � <br /> Address r <br /> l Zip Code tl Release# 44V City 7 f' PA( State <br /> L � 0 1=AX# 1 Site# � �� ,� ��r� <br /> Tele hone 6 1 ❑ Level A C <br /> 0 ��f Sam !er ee ffirG 0 Rj j C Data 8 Level tandard) ❑ Level C ❑ Level 13 a <br /> Re ort To C+,CO 0 Anal ses Requested <br /> Turnaround a 10 Work Days ❑ 5 Work Days ❑ 3 Work Days ❑ Drinking Water <br /> Time: ❑ 2 Work Das ❑ 1 Work Da ❑ 2-8 Hours ❑ Waste Water <br /> CODE: ❑ Misc ❑ Detect ❑ Eval ❑ Remed ❑ Demol ❑ Closure ❑ Other <br /> Client Date/Time Matrix #of Cont Laboratory Comments <br /> Sample I D Sampled Desc Cont Type Sample# 4 ' <br /> i W-- 4;�': 9 2 � <br /> 3 fh VV— 4 <br /> 4 A to_ q/}� >- <br /> 5 <br /> B <br /> 7 <br /> 9 ` a" <br /> r o <br /> 10 <br /> Received Date <br /> � Time � J <br /> Relinquished By Date 0 Time <br /> Time = <br /> Relinquished By Date <br /> Time Received B Date � <br /> Relinquished B Date Time Received B Lab <br /> Date [Time <br /> Condition?4 Yes❑No Samples on Ices C1 Yes❑No Method of Shipment <br /> Page�of <br /> Were Samples Received in Good <br /> To be completed upon receipt of report <br /> e Chain of Custody reported? ❑Yes❑No if no,what analyses are still needed <br /> i) Were the analyses requested on th <br /> uested turnaround time? ❑Yes o it no,what wasCtomPamyround time's $ <br /> 2) the report issued within the reqV <br /> AP - 1 y <br /> Signature <br />