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U 680 Chesapeake Drive•Redwood City,CA 940 15)364 9600 U 18939 120th Ave,N E, Suite 101 •Bothell,WA 98011 •40 81 9200 <br /> UA L ID / '�819 Sinker Ave,Suite 8•Sacramento CA 95834•(916)921 9600 U East 11115 Montgomery Suite B•Spokane WA 99206•(509)924 9200 <br /> U1900 Bates Ave,Suite LM•Concord,CA 94520•(510)686 9600 U 15055 S W Sequoia Pkwy SWe 110•Porliand,OR 97222•(503)624 9800 <br /> Company Name Q�'j#1G � tlIr011444AT-d OJ Project Name <br /> Address Z� s <;Q TrwL%. t qC e 2�*Z/tf D UNOCAL Project Manager <br /> Fl �} - S� <br /> City SQA 10,, State /� Zip Code t?51119 Release# t9Z1C9 <br /> Telephone I` `fY/ - eo 4 m <br /> p 'T� �II 7S FAX # � � �/�//"?S.�� Site it <br /> �1?0t <br /> Re ort To t CA u 0 ISampler /_ 'K 16#7- OC Data X Level D (Standard) ❑ Level C ❑ Level B ❑ Level A <br /> Turnaround P114 Work Days ❑ 5 Work Days ❑ 3 Work Das <br /> y CJ Drinking Water JAnalyses Requested <br /> Time ❑ 2 Work Das ❑ 1 Work Day ❑ 2-8 Hours U Waste Wat .� <br /> CODE ❑ Misc ❑ Detect ❑ Eval emed ❑ Demol ❑ Closure �d, Other#( <br /> Client Date/Time Matrix # of Cont Laboratory cj <br /> Sample I D Sampled Desc Cont Type Sample# Comments <br /> 20123, <br /> �2 <br /> 3 J <br /> 4 <br /> 0 <br /> 5 <br /> r <br /> 6 <br /> 7 <br /> B <br /> 9 <br /> 10 <br /> 0 <br /> cU <br /> 12 <br /> 0 <br /> Relinquished By Date 71301y6, Time D Received B Date /11041, Time <br /> Relinquished ByDate Time S- Received B Date Time <br /> i <br /> Relinquished By Date Time Received By Lab 7.��� Date47 DC7 Time <br /> Were Samples Received in Good Condition? Yes❑No Samples on Ice? Yes L) No Method of Shipment ..Se /d! - Pa9e of <br /> To be compteted report receipt of report <br /> 1) Were the analyses requested on the Chain of Custody reported? U Yes 0 No If no, what analyses are still needed? ---- <br /> 2) Was the report issued within the requested turnaround time? U Yes I„] No If no, what was the turnaround time? <br /> Approved by - _ -- ---------Signature _ _ _ -- -- _ — Company _ _ -- Date <br />