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U 680 Chesapeake Drive•Redwood City,CA 94063•(650)364 U 18939 120th Ave,N E Suite 101 •Bothell,WA 98011 •(206).1 9200 <br /> u N0OAL U 819 Striker Ave,Suite 8•Sacramento, CA 95834•(916)921* U East 11115 Montgomery Suite B•Spokane WA 99206•(506-9200 <br /> 'la(404 N Wiget Lane•Watnut Creek,CA 94598•(925)988 9600 ❑ 15055 S W Sequoia Pkwy,Suite 110•Portland,OR 97222•(503)624-9800 <br /> /U 1455 McDowell Blvd North Suite D•Petaluma,CA 94954•(707)792-1865 <br /> Consultant Company G-L T-T-L ER— Rw 10 C r Project Name —ORM Y A)Q C4( 18 —5 T-0Rj <br /> Address (o S� pyaq (� , Sl- "�e UNOCAL_ Project Manager r3p 0 LL S T <br /> City Q u ` n f State C Zip Code 5 6 8 AFE # �� Q <br /> "telephone N �5 T) 5�� 5 5 5"FAX # 515 { ` Site #, City, State 1 (p 6 5 PFK ( R C ti L Y [ ► m <br /> Report To (t (& K LJQ Sampler r K Cv f QC Data PeLevel D (Standard) ❑ Level C ❑ Level B ❑ Level A U <br /> X <br /> Turnaround U 10 Work Days Work Days ED 3 Work Days ❑Drinking Water Analyses Requested <br /> a <br /> Time 0 2 Work Days 0 1Work Day U 2-8 Hours ❑Waste Water <br /> CODE: ❑Misc ❑Detect ❑ Eval ❑ Remed ❑ Demol ©Closure em"Qther <br /> Client Date/Time Matrix # of Cont Laboratory O Comments <br /> Sample I D Sampled Desc Cont Type Sample # <br /> Cows -S D -313 so <br /> 1 C � <br /> Tu- <br /> 5 y000© r/ v v v ro <br /> 2 a <br /> ro <br /> 3 � <br /> 0 <br /> 4 — <br /> 5 <br /> 6 <br /> 7 <br /> 8 <br /> 9 <br /> M <br /> 10 n <br /> 1 11, fVA 11 ca <br /> J <br /> Relinquished By ate l ime �(�; Received By V Date 3 Time i�p m <br /> Relinquished By Date Time Received B0 Date Time <br /> Relinquished By Date Time Received By Lab Date Time <br /> Were Samples Received in Good Condition? Wes ❑No Samples on too? �es ❑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 Signature Company Date <br />