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UNOCALU 619 Striker Ave Suite 6•Sacramento,CA 950(9 16)921-9G00 U East 11115 Montgomery Suite B•Spokane WA 992060)924 9200 <br /> ❑ 404 N Wigel Lane•Walnut Creek,CA 94596. 510 986 9600 ❑ 15055 S W Sequoia P Suite 110•Portland OR 97222. 503 624 9800 <br /> ( ) q Pkwy, ( } <br /> Consultant Company l�C Fos= Protect Name UOS'4"' C <br /> Address 2 g L ) UNOCAL Protect Manager' <br /> City State Zip Code AFE# �(� - <br /> Telephon ' 2 <br /> �� (� - FAX # 7,2 Site #, City, State v <br /> Re ort To Sampler C,1E M-0 OC Data vel D (Standard) ❑ Level C ❑ Leve! B ❑ Level JA <br /> c <br /> ii <br /> Turnaround Work Days ❑ 5 Work Days ❑ 3 Work Days ❑ Drinking Water JAnalyses Requested <br /> Time ❑ 2 Work Das ❑ 1 Work Day ❑ 2-6 Hours ❑ Waste Water <br /> CODE: ❑ Misc 9-13tect ❑ Eval ❑ Remed ❑ Demol I] Closure Wther t��J <br /> 10 T Client Dale/Time Matrix # of Cont Laboratory Z` <br /> Sample I D Sampled Desc Cont Type Sample# /� 777"'''' Comments <br /> 1 -1z tz CO it I i a <br /> zCTL J1 ° <br /> 3 J <br /> 4 0 <br /> m <br /> 5 <br /> 6 <br /> 7 <br /> 6 <br /> 9 ' <br /> 10 $ <br /> ttl <br /> 0 <br /> Relinquished By ,Date ,2-JZ Time y Received 8 ate a 1me l J <br /> m <br /> Relinquished B Date ' / 9(• Time Cf. r <br /> q y y�- Received B Date / � Time r <br /> Relinquished By I DatiLfATime I Received By Lab adv Date.2 /O h Time l D <br /> Were Samples Received in Good Condition?❑Yes❑No Samples on Ice? U Yes J No Method of Shipment Page-of <br /> To be competed upon receipt ol report <br /> 1) Were the analyses requested on the Chain of Custody reported?*Yes IJ No If no, what analyses are still needed? <br /> 2) Was the re art Issued within the requested turnaround time? F'�e ❑ No If no, what was the turnaround tiTe? <br /> Approved by Signature �U ��'� ���J __Company ��'� �— _ Date r-') �U <br />