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rnt N ,ROP�>3xxE5 llnzci icalz EJIvF!'Ul?nzC11IaI N i k AEN Pago <br /> ress• 648 3440 Vincent Road,Plcasanl I MI,CA 9��85.1-46 8 Photic(510)930-9090 REQUEST FOR ANALYSIS I CHAIN OF CUSTODY <br /> act John M owski 1 AX(510)930-0256 Lab Job Number Contact Lab Domination <br /> Date Samptos Shipped <br /> Address Report 7g: Send Invoice To- Lab Contact- <br /> 2- Western Geo—Engineers 3. Sam.0 As #1 Date Results Required: <br /> 1386 C. Beamer Street Date Report Required <br /> Woodland, CA 95776-6003 Cllont Phone No- <br /> --- Client FAX No- <br /> Send Report To t or 0 (Circlo one) ANALYSIS <br /> Client P 0 No Clionl Project I D No _ 603 <br /> i <br /> Sample Team Member(s) Q t <br /> Lab Client Sample Air Name Sample No Type k - <br /> i <br /> Number IndenliCicallon Volume Type' Pres of of <br /> CoHecled yP Cont. Coni Comments I Hazards ' <br /> amt In uz__2 _- CL Z <br /> Rb _ 11.'06 E-1v� crr,Ot Lor I <br /> _ �-•�3 _ 77 — LO-�Zkr nr i3i , <br /> — 1J1� rrrn�. i t <br /> !}tL E <br /> Rerinquishod by- DATE TIM //��''� Received by' DTE TIME <br /> (Signature) 6 12- F,7 16) (Signature) <br /> Rermqu3shed by DATE T17E Rocolvod by DATkAZ2 TIME <br /> (Signature) 6 -/2 '9 7 Qv (Signature) <br /> not'inquishod by DATE TIME Received b D TIME <br /> (Signaluro) <br /> (Signature) ' <br /> AAethod of Shipment Lab Comments r, <br /> r <br /> 'Samplo typo(Spoafy): 1)37mm 0 8 pm MCEF 2)25mm 0 8 Pm MCEF 3)25mm 0 4 pm polycarb Gltor <br /> 4)PUC filter, diam .4_ pore slZe 5)Charcoal lube 6)Silica got tube (Z)Wator 0)Soil 9)Bulk Samplo <br /> 10)Olhor_ 11)Other `r <br /> COPIES WINTE•,i011FILE YELLOW PPIf7JECTFILE PINK CLIENT { <br /> f <br />