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Industrial Blvd. <br />Wes ^_'� <br />West Sacramento, CA 95691 <br />Tel: 916.372.1434 Lab No. VPage lof <br />c"`<' ` Fax: 916.372.2565 <br />WKA Carbon Copy addresses <br />irosenbery at7.wallace-kuhl.com <br />dnakamoto(a)wallace-kuhl.com <br />Dyes ❑No <br />California EDF Report? <br />Chain -of -Custody Record and Analysis Request <br />Project Manager (Hardcopy or PDF To): Dennis Nakamoto <br />WKA Email Address: dnakamoto@wallace-kuhl.com <br />Analysis of Request <br />Q <br />H <br />Company / Address: <br />see above <br />Recommended but not mandatory to complete this section: <br />Sampling Company Log Code: <br />o <br />W <br />o <br />a <br />Q <br />1�Hr <br />21 <br />c <br />O <br />w <br />m <br />Phone No.: <br />see above <br />Fax No.: <br />see above <br />Global ID: <br />24 Hr <br />O <br />Project Number: <br />13221.02 <br />P.O. No.: <br />EDF Deliverable To (Email Address): <br />48Hr <br />Project Name: <br />Westlake Villages E, G, H, I, J <br />Sampler <br />Signature: <br />76r <br />Project Address: <br />barnpling <br />on alner <br />Preservative <br />at rlX <br />Date <br />Time <br />v co <br />E E <br />' o O <br />to N <br />- = 0 <br />o o"" W <br />= z=_ 2 <br />W <br />Q <br />to <br />KWSample <br />r2W <br />Desi nation <br />K <br />2/ <br />� J <br />�6 SSA .A <br />7� <br />C�. <br />` G <br />l/ <br />I <br />C)OA <br />liiU� <br />R <br />Relinquis <br />Date <br />Time <br />Received by: <br />Remarks: <br />please send copy of report to jcoburn@wallace-kuhl.com <br />Relin i e <br />Date <br />Time <br />Received by: <br />Relinquished by: <br />Date <br />Time <br />Received by Laboratory, <br />ei <br />1/ —2::�/ / //,A'7-1 <br />Bill to: Wallace -Kuhl & Associates c/o <br />WKA Contact and swilliams@wallace-kuhl.com <br />