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i <br /> Ii. CGene WICKLAND PROPERT].ES– A171C11Cp11 Environniewa!Petwork AEN Pago of <br /> Address- P.O. Sax 13648 3540 Villccnt Road,Plcasanl hill.CA 94523 REQUEST FOR ANALYSIS r CHAIN OF CUSTOD' <br /> S++r_r,_-rnMento, Ch 958-53--46 10 Phone(510)930.9090) <br /> Contactjohn Ma_r_c�owskl _ <br /> rAX(510 930-0256 Lab Job Number q�0G 1_Z <br /> i <br /> Alt.Contact <br /> Lab Destination <br /> Dale Samples Shipped <br /> Address Report To: Send Invoice To. Lab Contact. <br /> 2. Western Geo–Frlgineeira s. Delo Results Required' <br /> Same As 01 Data Report Roqulrod <br /> j 13.06 E._Seamer Street: Cllont Phone No <br /> Woodland, CA 95176-6003 Client FAX No. <br /> '�. ANALYSIS <br /> Send Report To I or 2 (Clrclo ono) 1 <br /> Client P 0.No.- COW Prolect 1.1) No <br /> Sample Team Member(s) _ M <br /> Lab Client Sample Air ale Sample No Type ` \� <br /> Number IndenllGcalion Volume Collected Type pre$ Cont Coni of of Comments 1 Hazards <br /> oma ._ 2-1111-0 -- - <br /> 0-365 <br /> IA AZ M �✓ — <br /> L2 A —— — <br /> Q-6-/� ` i w— — - %5l <br /> kVAS MW I _ Il(`Y <br /> Mw �_� — <br /> B /Vtt 37 <br /> =H=E I <br /> I zHS M W <br /> Relinquished by, DA TIME r Received by. A TIME <br /> H=H <br /> (S'Ina (Ssgnaluro) J <br /> nefincpshod by TI; TIME Rocolvod by DATE TIME <br /> lSignature) Com_ (Signature) Iva,lq6 17 , 00 <br /> not; 'shad by/ DA -TIME Recolvod by. DATE TIME <br /> (sign3luro) (Slgnaturo) <br /> Method of Shipment Lab Comments +' <br /> `Sample type(Spocily) 1)37mm 0.0 pm MCEF 2)25mm 0.0 pm MCEF 3)25mm 0 4 pm polycarb Gllor <br /> 4)PVC filler, dram pare slzo 5)Charcoal tubo 6)SMca got tubo 7)Walor 0)Sod 9)Bulk Sample <br /> 10)Olhor I 11)Olhor <br /> COPIES 1" OIE-JOBFILE YELLOW-PnWECTFILE PINK-CLICHT <br />