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V I%A Ak <br /> /, L U O 1 J 00IKUI HVU,JUIIU U•.�rll,l dl1 WI It(),UjH JJlP)) <br /> /Ib)JL I Juuu ISI tasl I l I In munlyunlHry,ouatj U-opuKal lu. vvk JJNu ycH Je VV <br /> r „ U 404 N Wipt l alle•Wnlrnfl Crerk,CA 945913• 986 9600 U 15055 S W SQquofa Pkwy,State 110•Penland,OR 97222• 3)624 9800 <br /> Consultant Company I G GWS Protect Name '3 to _()'(p-5A <br /> Addressg '50C �clg7 <br /> 2�U p UNOCAL Protect Manager <br /> City � ' State Zip Code 0 AFF It <br /> _ C <br /> Telephone FAX# ! Y(,- J Site It, City, State CA <br /> Re ort To i-C-PAVC ISampler <br /> S�JWJ Nvl-vo QC Data ❑ Level D (slandard) ❑ Level C ❑ Level B ❑ Level A <br /> Turnaround&Q'10 Work Days 0 5 Work Days ❑ 3 Work Days ❑ Drinking Water JAnalyses Requested <br /> Time ❑ 2 Work Das ❑ 1 Work Day ❑ 2-8 Hours ❑ Waste ateri <br /> CODE ❑ Mlsc ❑ Detect ❑ Erval ❑ Remed 13 Demol 13 Closure A Other � �60M <br /> Client Date/Time Matrix it of Cont Laboratory <br /> Sample 1 D Sampled Desc Cont Type Sample It Comments <br /> 1 jN4Z, (31W t000 A W 7„voe, 01 <br /> 2 �o6s D2 o <br /> a J <br /> 4 3 <br /> 0 <br /> 5 <br /> 6 <br /> 7 <br /> 6 <br /> 9 <br /> i0 0 <br /> ctY <br /> O <br /> CU <br /> Relinquished By Date Time 1,5(C) Received B Da lime <br /> m <br /> Relinquished By Date Time Date Time <br /> Relinquished B ate ITime I Received By Lab /0Date �1 Time � <br /> Were Samples Received In Good Condition?Q Yes❑No Samples on ice? 0 Yes U No Meth(6 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 U 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 Signature _ _ ____Company Date <br />