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Fleporling Informatit3Fr 0,9,4 1..,4,8 14-0� 0 0 <br /> 1 Client WICKLAND PROPERTIES A►►re►scan Lnvu onmental Netwvl k AEN Page of <br /> Address P.O. Box 13648 3440 Vmcenr Road,Pleasant I I10,CA 94523 REQUEST FOR ANALYSIS/CHAIN OF CUSTODY <br /> A 95853-46 8 I'hnnc(510)910 9090 T�C 1101 <br /> M_a <br /> Contacl _John rgowskl I AX(510)930 0256 Lab Job Number <br /> All Contact Lab Destination <br /> Date Samples Shipped <br /> Address Report To Send Invoice To Lab Contact <br /> Date Results Required <br /> 2 Western Geo-Engineers 3 Same A_s #1 Date Repan Required � <br /> 1386 E. Beamer Street <br /> Woodland, CA 95776-6803 Client Phone No <br /> Client FAX No <br /> Send Reporl To I or (Circle one) ANALYSIS <br /> Client P O No Cient P olecIII) No Q <br /> Sample Team Member(s) 6 <br /> Lab Client Samle Air Date/ Sample No Type <br /> Number Intlenlificatron Volume Time Type, Pres of of <br /> Collected Cont Coni Comments!Hazards <br /> _ JW I a X <br /> Joe 1x_Y— <br /> I <br /> I <br /> j Relinquished by DATE gME Received by DATE t TItAE <br /> (Signatur 0 L AAR ./Z-q /6,0 :!;— (Signature) <br /> r <br /> Regngvishe d by C- ATE TME Received by _ h + �AT I Z�`f TIMP MO 3t)(Sr nature �l3 �a 4" „ 3(� (Signature) U- <br /> Relinquished DATE TIME Received by DATE TIME <br /> (Signature) (Signature) <br /> Method of Shipment Lab Comments <br /> Y <br /> 'Sample type(Specify) 1)37mm 0 8 pm MCEF 2)25mm 0 8 pm MCEF 3)25mm 0 4 pm polycarb filler <br /> 4)PVC filter diam pare size 5)Charcoal tube 6)Slilca gel tube 7)Water 8)Soil 9)Bulk Sample <br /> 10)Other 11)Other <br /> COPIES WHITE J09FILE YELLOW PRWECTFILE PINK CLIENT <br />