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Reportingintormat! <br /> Aineticnn Envirownentatsvoik ALEN <br /> 1 Client KLAND PROPERTIES Page f <br /> Address IM. B K 1_3648 3440 Vincent Road,Pleasant Hill, 4523 REQUEST FOR ANALYSIS!CHAIN OF CUSTODY <br /> SACRAMENTO , C_A95853 4648 Phone(510)930-9090 <br /> Contact JOHN MARGOWS KI I AX(510)930 0256 Lab Job Number D <br /> Alt Contact Lab Destination <br /> Date Samples Shipped <br /> Address Report To Send Invoice To Lab Contact <br /> 2 WESTERN GEO-ENGINEERS 3 Date Results Required <br /> _ SAME AS 01 Date Report Required <br /> 1386 E._BEAMt'.R STREET _ Client Phone No - <br /> WQODi.A111D,_ CA ___95776-6170.3 _ Client FAX No <br /> ANALYSIS <br /> Send Report To 1 or 2 Circle one) <br /> Client P O No 8603 Client Project i D No <br /> Sample Team Member(s) <br /> r� <br /> d <br /> Lab Client Sample Air Dale/ Sample No Type r <br /> Number Idenitflc,llton Volume Time Collected Type. Pres Cof of <br /> nt Cont Comments/Hazards <br /> 01,4 <br /> 59'v- <br /> 636 <br /> 9'v 63R � — �lr <br /> o U y- — <br /> �+- r a <br /> its' ins T— <br /> QT4 <br /> S{�y --Gr' llto fi3" <br /> 1 1,r <br /> DS- <br /> S" o O <br /> 104 105'-6 1 <br /> Of <br /> G! Gag <br /> i <br /> Relinquished byATE TIME <br /> (Signature) Received by DATE TIME <br /> r�9'7 (Signature) <br /> Relinquished by D TE /TI�E Received by T TIME <br /> (Signature) `L.�( (Signature) ` <br /> Relinquished by r TI Received by / DATE TIME <br /> (Signature) „G f j (Signature) '( S <br /> Method of Shipment ZL' <br /> Lab Co <br /> °Sample type(Speedy) 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)Charcoai tube 8)Silica gel tube 7)Water 8)Sod 8)Bulk Sample <br /> 10)Other- 11)Other <br /> COPIES WHITE JOB FILE YELLOW PROJECT FILE PINK CLIENT <br />