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Iieporling Inlormalioo i <br /> 1 Client w CKLAND PROPERTIES Amer, tcuir Lirtiri ouln wul Ai k AEN Page of <br /> Address O x 13648 3440 VIIICCIII Rwd,Pic.tsani I lill,CA 94523 REQUEST FOR ANALYSIS!CHAIN OF CUSTODY <br /> SaCramento, CA 95853-4618 11hunc(510)930-9090 <br /> Contact John Mar owski [-AX(518)930 0250 Lab Job Number <br /> All Conlacl Lab Destination <br /> Date Samples Shipped <br /> Address Report To Send Invoice To Lab Contact <br /> 2 western Geo—Engineers 3 Date Results Required <br /> Same As Ill _. Dale Report Required <br /> 7 386 E. Beamer Street Client Phone No <br /> Woodland, CA 95776--6003 Client FAX No <br /> r <br /> Send Report To 1 or�? (circle one) + �Q <br /> Client P O No Client P olect 10 No <br /> Sample Team Member(s) 4u' b <br /> Lab Client Sample Air Date/ Sample No Type <br /> Number Indentdtcallon Volume Type Pres of of <br /> Collected Coni Cont Comments!Hazards <br /> fAirAx) v X <br /> AMt —�-- <br /> Relinquished by DATE `SME Received by DAT TIME <br /> (Signature) ./yq `V�� (Signature) lG ! <br /> Relinquished by DATE TIME Received by DATE TIME <br /> (Signaluie) (Signature) <br /> Relinquished by DATE TIME Received by DATE TIME <br /> (Signature) (Signature) <br /> Method of Shipment Lab Comments <br /> r, <br /> 'Sample type(Specily) 1)37mm 0 8 Nm MCEF 2)25mm 0 8 um MCEF 3)25mm 0 4 Nm polycarb filler <br /> 4)PVC filler diam pore size 5)Charcoal tube S)Silica gel tube 7)Water 8)Soil 9)Bulk Sample <br /> • 10)Other 11)Other <br /> COPIES MITE J06 FILE YELLOW PROJECT FILE PINK CLIENT <br />