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F1e r1, Information°� Anrei scan En vu onniental Netwoi k AEN Nage of <br /> 1 Client _WLCKLAND_PROPERTIES _ 3440 Vincent Road,Pleasant II111,CA 94523 <br /> Address P-O. Box 13648 REQUEST FOR ANALYSIS!CHAIN OF CUSTODY <br /> Sacramento CA 95853-4618 <br /> Phone(5 10)930-9090 <br /> Contact John Margowski I-AX(510)930 0256 Lab Job Number <br /> Lab Destination <br /> All Contact <br /> Dale Samples Shipped <br /> Address Report To Send invoke To Lab Contact <br /> 2 Western Geo-Engineers Date Results Required <br /> Same As #1 <br /> Date Report Required <br /> 1386 U. Beamer Street Client Phone No <br /> Woodland, CA 95776-6003 Client FAX No <br /> r ANALYSIS <br /> Send Report To 1 or 2 (Circle one) <br /> Client P O No Client Pro ect I D No <br /> Sample Team Member(s) r <br /> Lab Client Sample Air Dame Sample No pies of Tole <br /> Number Indentlficatlon Volume Collected Type. Cont Cont Comments I Hazards <br /> ftd <br /> G <br /> r <br /> W r ! <br /> r <br /> _fin KJ-- 9 _ <br /> v <br /> 17 of <br /> Relinquished by DATE TIME Received by A DATE TIME <br /> (Signature) 3' _5 d (Signature) ., � <br /> Relinquished by DATE TIME Received —D-Al TIME <br /> (Signature) (Signature) <br /> Rehnqu,shed by DATE TIME Received by DATE TIME <br /> ISignalure) (Signature) <br /> Method of Shipment Lab Comments <br /> r, <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 filter, dram pore size 5)Charcoal tube 6)Silica gel tube 7)Water 8)Soil 9)Bulk Sample <br /> t0)Other 11)Other <br /> COPIES WHILE J00 FILE YELLOW PROJECT FILE PINX n I6Nr <br />