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Reporting Informatioe . <br /> 1 Client WICKLAND PROPERTIES AmCI icon Envu U11111enful IVC'twoi k A.L.:11 ■ Page of <br /> Address R.O._Box 13648. 3440 Vincent Iiwd,Pleasing I fill,CA 94523 REQUEST FOR ANALYSIS!CHAIN OF CUSTODY <br /> CA 95853-4618 Plionc(510)910 9090 <br /> Contact John Margows_ki. I AX(110)910 0250 Lab Job dumber <br /> All Contact Lab Destination <br /> Dale Samples Shipped <br /> Address Report To Send Invoice To Lab Contact <br /> 2 Western Geo—Engineers 3 Date Results Required <br /> 13$6 E. Beamer Street Samc. As It 1 � Dale Report Required � <br /> Client Phone No <br /> Woodland, CA 95776-6003 <br /> Client FAX No <br /> Send Report To 1 0C (Circle one) ANALYSIS <br /> L <br /> Client P O No Client Project I No <br /> Sample Team Member(s) a <br /> k <br /> Lab Client Sample Air Date/ Sample No Type <br /> Number Indentlhcation Volume Time Type. Pres of of <br /> Collected Cont Coni r Comments 1 Hazards <br /> /0//44FL Z —— <br /> Gr c r✓—z- __ �- 31w <br /> Al — !L 1a rc <br /> Relinquished by DA E TIME Received by �A TIME <br /> (Signature) _"�j(, (Signature) ![/ �� t <br /> A� <br /> Relinquished by OATq TIME Received by DATE TIME <br /> (Signature) (Signature) <br /> Relinquished by DATE TIME Received by DATE TIME <br /> (Signature) (Signature) <br /> Method of Shipment Lab Comments <br /> r. <br /> 'Sample type(Specify) 1)37mm 0 6 Nin MCEF 2)25mm 0 8 pm MCEF 3)25mm 0 4 pm polycarb filter <br /> 4)PVC filler, diam pore size 5)Charcoal tube 6)Silica gel tube 7)Water 8)Soil 9)Bulk Sample <br /> 10)Other 11)Other <br /> COPIES Wt9ITE JOB FILE YELLOW PA13JECT FILL: PINK CLIENT <br />