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Reporting Intorm...,dn: <br /> . ti. <br /> 1. Client: Wlr.K-4AND PROPERTIES American Environmental Network AEN <br /> Address: X {3648 <br /> 3440 Vincent Road,Pie, FIi1{,CA 94523 Page al 1 <br /> 9,A .,95853-46,18 Phonc(510)930-9090 REQUEST FOR ANALYSIS!CHAIN OF CUSTODY <br /> Contact: John M owski FAX(510)930-0256 Lab,lob Number: <br /> All.Contact: Lab Destination: <br /> Date Samples Shipped: <br /> Address Report To: Send Invoice To: Lab Contact: <br /> z- Western Geo—Engineers 3. Same As 41 Date Results Required: <br /> Beamer E. 8eaer Street Dale Report Required:`� <br /> Woodland, CA 95776-6003 Client Phone No <br /> Client FAX No.: <br /> Send Report To: 1 or 2 Circle one) ANALYSIS <br /> Client P.O.No.: ' Client Project I.D.No.: <br /> Sample Team Member(s) 7G�/yR <br /> le <br /> Lab Client Sampleq;r Date/ Sample No. Type <br /> Number -Indentificallon Volume Time Type, Pres. of of <br /> Collecled Cont. Cont. Comments/ Hazards <br /> otc� <br /> k� <br /> Relinquished by: 0e, DATE TIME Received by: DATE TIME <br /> (Sjgnafure) �z /�l�� 7 d (Signature) , <br /> Relinquis1 17 21 1 <br /> hed by: DATE TIME Received b <br /> (Signature) "� (Signature)y <br /> Relinquished ATE TIMff Received by: ATE TIME <br /> (Signature) (Signature) <br /> Method of Shipment Lab Comments <br /> pQ. <br /> ample type(Specify): 1)37mm 0.9 Nm MCEF 2)-25mm 0.8}rm MCEF 3}25mm 0.4 um polycarb.filter <br /> 4}P.VC.tillar.,diam._ ro sEzo 5)Charcoal tubo i.6);S3(iEar gel tut?e -7)Water 8)Soil 8};_(3ulk SAmple <br /> t0)a?lher. t 1)Other. <br /> -CC0MES:v AI UTE.•i00 FILE. :YF11xM".PAnMf--r rri c. ��- <br />