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+1Lyvn+11y 4110rmabor w <br /> 7. Client AND PROPERTIES <br /> Amej icon E11 i111'onniental joi k AEN Page of <br /> Address P.O. I3ox 13648 3440 Vinctul Road,Picainni i Itit,CA 94523 REQUEST FOR ANALYSIS 1 CHAIN OF CUSTODY <br /> .-Sacrm ent!2, CA 9585:1-4 18 Mone(510)930.9090 <br /> Contact John +htargowski. FAX(510)930-0256 Lab Job Number <br /> AIL Contact Lab Destination <br /> Dare Samples Shipped <br /> Addess Report To Send tnvoiee To Lab Contact <br /> Date Results Required <br /> 2- Western Geo-Engineers 3 Same As #1 Date Report Required - <br /> 1386 E. Beamer St.reetr Client Phone No <br /> Woodland, CA 95776-6003 — -- - - Client FAX No <br /> ANALYSIS <br /> Send Report To 1 or 2 (Circle one) , <br /> Ciieni P 0 No Client Project 1 D No3 - - - <br /> Sample Team Member(s) Date/ <br /> Lab Client Sample Art Time Sample Presof <br /> . No <br /> Number indentlllcabon Volume Time Type' o! <br /> Collected Cont. Cont a Comments/Hazards <br /> fte4nby � DAT TIME Received Y TIME <br /> Signature) ( gawe <br /> Refinquished by DTE TIME Received by, DATE TIME <br /> �Sagnature) (Signature) <br /> leFinquished by DATE TIME Receivod by DATE TIME <br /> ,Signature) (Signature) <br /> Nelhod of Shipment Lab Comments <br /> 'Sample type(Specify) 1)37mm 0 8 pm MCEF 2)25mm 0 8 pm MCEF 3)25mm 0A pm polycarb liter <br /> d}PVC filler, dram — pore silo 5)Charcoal tubo 6)Silica gel tube 7)Water 8)Sad 9)Bulk Sampte <br /> r <br /> 10)Other 11)Other <br /> COPIES YOUTE JODFtLE YELLOW-PRCUECTFILE PINK CLIENT <br />