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Reporting rnrormatron ^ �� O <br /> 1 Cent WICKLAND PROPERTIES n11C1lcan r/tip//O//// ental Netwo/k AEN Page. of -/ - <br /> Addross P.O. %qx 13648 _ 1440 VlnLl.111 Ruld,I'Ic isln1 I lila,CA 94523 REQUEST FOR ANALYSIS/CHAIN OF CUSTODY <br /> _ Sacramento. CA 95.853 -46 16 Phonc(510)910 9090 <br /> Contact -John Margowski _ I AX(510)930 0256 Lab Job Number <br /> Alt Contact Lab Destination <br /> Dalo Samples Shippod <br />'lldtfress Report To Send Invoice To Lab Contact <br /> 2 Wes tez n Geo—Engineers 3 Date Results Required <br /> Same /1s III <br /> 1386 C. Roamer Street Date Report Required <br /> _ <br /> Woodland, CA 95776-6003 Client Plione No <br /> Client FAX No <br /> I <br /> ANALYSIS <br /> Send Report To 12 (Circle Ono) <br /> Client P 0 No Client Prolrcl I D No <br /> Sample Team Member(s) <br /> Lab Client Sam1i+ Atr Cate/ sample No Type <br /> Number Indenir6caUort VolumeTtme Type. Pres of 01 <br /> _ �Cololte�cled Cont Cant Comments/ Hazards <br /> I <br /> Relinquished by �D TE TIME Received by DAT TIME <br /> (Signature) /'z � -��'C S �Q (signature) <br /> Relinquished by ` DTE 1, TIME Receivedby DA i TIME <br /> (Stgnalutc) {fit 7 (( (Signature) I/�� 3 1 C L <br /> Relinquished by DATE TIME Rccorvod by DATE TIME <br /> (Signature) (Stgnaturo) <br /> i <br /> Method of Shipment Lab Comments <br /> r , <br /> 'Samplo type(Specify) 1)37rnin 0 B lrm MCEF 2)25mm 0 0 Iim MCCF 3)25rnm 0 4 lint patycaib Idler <br /> 4)PVC t,ltrr dram pore size 5)Charcoal tubo Q Sdtca pet tube 7)Water 8)Sod 9)hulk Sample <br /> 10)Olhor 11)Other <br />