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Reporting Information Ah <br /> � <br /> 1. Client WIC ND PROPERTIES American Envtronrnental Nerk t4EN Pago o <br /> Address_ — 3440 Vincent Road,Pleasant till[,CA 94523 REQUEST FOR ANALYSIS t CHAIN OF CUSTODY <br /> ,SACRAMEtiTO , CA 95853 4648 Phone(510)930-9090 <br /> Contact LJOHN MAR912WSKI FAX(510)930-0256 Lab Job Number _. �i Rt`13n 7 <br /> AIG Contact. <br /> 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 A S #1 Date Report Required <br /> 1 186 E- BEAMER STREET Client Phone No - <br /> WOODLAND, CA 997715-fin{l-L- Client FAX No <br /> ANALYSIS <br /> Send Report To I or 2 (Circle one) <br /> Client P.O No- Client Project I D No <br /> Sample Team Member(s) G-t rete <br /> Lab Client Sample Air Dalet Sample NoYe / <br /> Number idenhficaUon Volume Co cted me hype' Pres P <br /> Cont Con[ Comments/Hazards <br /> AFL <br /> Re]Mwshed by DATE TIME Received / DAT TIME <br />(Signature) 3-�-� G,' f"-�j (Signature) Qom <br /> Relinquished by- - DATE TIME Received y UAth TIME <br />(Signature) (Signature) <br /> Relinquished by' DATE TIME Received by DATE TIME <br />(Signature) (Signature) <br /> Method of Shipment Lab Comments <br /> 'Sample type(Specify) 1)37mm 0 8 pm MCEF 2)25mm 0 8 pm MCEF 3)25mm 0 4 pm polycarb filter <br /> 4)PVC lister, diam pore size 5)Charcoal tube 6)Silica gel tube 7)Water 8)Soil 9)Bulk Sample <br /> 10)Other__ 11)Other <br /> COPIES WRITE JOB FILL: YELLOW PROJECT FILE PINK CLIENT <br />