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Reporting Inlormali <br /> Alae! tcan Eli vr1 olllnenlal Ne titiwi k AEN Fuge of <br /> 1 Client WICKLAND PROPERTIES <br /> 3440 Vincent kuacl,l'Icasant llrll,CA 94523 REQUEST FOR ANALYSIS 1 CHAIN OF CUSTODY <br /> Address p.o. Box 13648 <br /> A 5853-46 >3 1111011C 15101910 9090 S Q3 <br /> John Margow A I AX(510)930 0256 Lab Job Number <br /> Contact - -- Lab Destination <br /> Ail Conlacl Date Samples Shipped <br /> Address Report To Send Invoice To Lab Contact <br /> Date Results Required <br /> 2. Western Geo—Engineers 3 Sgime As #1 Date Report Required <br /> 1386 C. Beamer Street Client Phone No <br /> Woodland, CA 95776-6003 Client FAX No <br /> r <br /> ANALYSIS <br /> Send Reporl To 1 or 2 (Circle one) ' d <br /> 3 <br /> Client P 0 No Client F ro ect 10 No - <br /> Sample Team Member(s) <br /> Ivo Type <br /> Lab Client Sample Air Tlame Sample Pres of of Comments/Hazards <br /> Dumber Indent{Icalion Volume Collected Type' Conl Cont <br /> t� _ _ _ <br /> 0�f4PS-- 3Je �� 2 �. - ___ —y {,��,JU [S yrt 14 to <br /> GUAL—14A (A <br /> �,1�11�'LJ'Mfl)l at Weir <br /> I • <br /> a <br /> DATE TIME Received by DATE TIME •`z� <br /> Relinquished by o (Signature <br /> (Signature) •� <br /> ATE TIME <br /> Relinquished by <br /> DATF TIME Received <br /> —' (Signature) <br /> (Signature) TIME <br /> DATE IM Received by DATE <br /> Relinquished (Signature) <br /> (Signature) <br /> Lab Comments <br /> Method of Shipment <br /> 'Samplo type(Spocdy) 1)37mm 0 8 pm MCE;F 2)25mm 0 8 pm MCEF 3)25mm 0 4 pm poiycarb Idler <br /> 4)PVC filter diam pore size 5)Charcoal tubo 6)Silica gel tube 7)Water 8)Sod 9)bulk Sample <br /> 10)Other 11)Other <br /> COPIES WHITE J013FILE YELLOW PROJECT FILE PINH CLIENT <br />