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Client <br />Sample I.D. <br />❑ 6680 Chesapeake Drive • Redwood City, CA 94063 • (415) 364-9600 ❑ 18939 120th Ave., N.E., Suite 101 • Bothell, WA 98011 • (206) 481-9200 <br />Matrix <br />Desc. <br />Immu® <br />ff 819 Striker Ave.. Suite 8 • Sacramento, CA 95834 • (916) 921-9600 ❑ East 11115 Montgomery, Suite B • Spokane, WA 99206 • (509) 924-9200 <br />•� <br />Gly. 0. — /— /D�2`1 <br />❑ 1900 Bates Ave., Suite LM • Concord, CA 94520 • (510) 686-9600 ❑ 15055 S.W. Sequoia Pkwy, Suite 110 • Portland, OR 97222 • (503) 624-9800 <br />Date: <br />Company Name: <br />Project Name: <br />Time: lReceived B <br />Address: evo'z C4rrho 'P— <br />(} <br />UNOCAL Project Manager: <br />- <br />o tOpen <br />� <br />City: Wob ae,00 vA State: <br />Zip Code: lS6 70 <br />Release #: <br />.� <br />Telephone: &31- /-To o <br />FAX #: (gs`) (o,5/- 1,,317 <br />Site #: <br />c <br />U <br />SGRM �✓ <br />./Yob <br />Re ort To:Sam <br />ler: >a® ® F� <br />QC Data: evel D (Standard) ❑ Level C ❑ Level B ❑ Level A <br />Turnaround ❑ 10 Work Das <br />y 5 Work Days ❑ 3 Work Days ❑Drinking <br />Water [Analyses Requested <br />Time: ❑ 2 Work Das ❑ 1 Work Da ❑ 2-8 Hours ❑ <br />Waste Water <br />CODE: ❑ Misc. ❑ Detect. ❑ Eval. <br />❑ Remed. ❑ Demol. ❑ Closure ❑ <br />Other <br />Client <br />Sample I.D. <br />Date/Time <br />Sampled <br />Matrix <br />Desc. <br /># of <br />Cont. <br />Cont. <br />Type <br />p �` y ��'\Yv <br />Laboratory tk tiO , <br />Sample # �4 eo'� �s� t1'� �'� Comments <br />Gly. 0. — /— /D�2`1 <br />Time: f1 Z0 Received BY: <br />Date: <br />Time: <br />Date: <br />Time: lReceived B <br />I DatZS <br />Time: ( L-6 <br />- <br />o tOpen <br />� <br />SGRM �✓ <br />./Yob <br />i <br />1. <br />1. <br />0. <br />Relinquished By: <br />Relinquished B . <br />Relinquished BL <br />� '— <br />Date: S iS- <br />Time: 10S'® Received By: - .�Q� <br />Date:�ls' <br />Time: Q SU <br />z�(% <br />Date <br />Time: f1 Z0 Received BY: <br />Date: <br />Time: <br />Date: <br />Time: lReceived B <br />I DatZS <br />Time: ( L-6 <br />Were Samples Received in Good Condition?� Yes ❑ No Samples on Ice? /Yes ❑ No Method of Shipment . 5:ec' f 0114 Page _ of _ <br />To be completed upon receipt of report: <br />1) Were the analyses requested on the Chain of Custody reported? ❑ Yes O 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 />0 <br />cis <br />0 <br />.Q <br />co <br />J <br />0 <br />as <br />r <br />z <br />0 <br />W <br />0 <br />crs <br />J <br />(D <br />