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Reporling InforrrT�lron <br /> I Client w CK16AND PROPERTIES Amer scan En vu oninenlal Nervl�ol k AEN Page' of <br /> Address P.O. Box 13646 3440 Vincent Road,Plcasani lull,CA 94523 <br /> A 95853-46 B Phonc(510)930-9090 5�?j REQUEST FOR ANALYSIS/CHAIN OF CUSTODY <br /> Conlact John +Mar2owski. FAX(510)930-0256 1�,��� Lab Job Number 2 <br /> All Contact Lab Destination <br /> Date Samples Shipped <br /> Address Report To Send Invoice To Lab Contact <br /> 2Western Geo–Engineers 9 Date Results Required <br /> Same As #1 Date Report Required <br /> 1386 C. Beamer Street <br /> Woodland, CA 95776 Client Phono No <br /> Client FAX No <br /> Sand Report To 1 or 2 Circle one) ANALYSIS <br /> Chant P O No Ghent Protect I D No _L• �"" <br /> Sample Team Member(s) <br /> Cn <br /> Lab Client Sample Air Date/ Sample Pres of Type � <br /> Number Indenlihcation volume Collected Type Cont Cont Comments 1 Hazards <br /> Relinquished by DAJE TIME Received by DATE TIME <br /> (Signature) �L /1 ��' 1 7 (Signature) r <br /> Relinquished by DATE TIME Received by b 11E TI <br /> (Signature) (Signature) J �` r —5 <br /> Relinquished PIATE TIME Received by v bAT TIME <br /> (Sighodnature) r lam, J�. ( "' (Signature) 'Z �?� 5 {'} <br /> el <br /> ts <br /> Mof Shipment Lab Comments <br /> , <br /> 'Sample type(Specify) 1)37mm 0 8 Vm MCEF 2)25mm 0 8 pm MCEF 3)25mm 0 4 pm potycarb filter <br /> 4)PVC tiller, diam pore size 5)Charcoal tube 6)Silica gel tube 7)Water 0)Sal 9)Sulk Sample <br /> 10)Other 11)Other <br /> COPIES WNITE JOB FILE YELLOW PROJECT FILE PINK rl IFNT <br />