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f1k!PU4t1J19411IUMIdl1V11 <br /> American Envrronmenta ttivoik AEN <br /> 1 ClientWKLAND PROPERTIES Page-0 <br /> Address Box 13648 3440 Vincent Road,Pleasant 523 REQUEST FOR ANALYSIS/CHAIN OF CUSTODY <br /> SACRAMENTO , CA 95853-4648 <br /> Phonc(51U)930-9090 U90 <br /> f A <br /> Contact JOHN M W K X(5 I U)930-0256 Lab.fob Number <br /> All Contact Lab Destination <br /> Date Samples Shipped <br /> Address Report To Send Invoice To Lab Contact <br /> Date Results Required <br /> WESTERN GEO-ENGINEERS 3 _ SAME AS #,1 Date Report Required <br /> 1 386 F- BEAMIE;R STREET _ Client Phone No <br /> WOODT.AND CA _ Client FAX No <br /> ANALYSIS <br /> Send Report To 1 or 2 (Circle one) <br /> Client P 0 No pj�o-? Client Project 10 No ,\ <br /> Sample Team Member(s) <br /> Lab Client Sample Air Date/ Sample No Type <br /> Number Identification Volume Time Type. Pres of op <br /> Collect Cont Cont Comments/Hazards <br /> DIA S — l s Py ,rh,0164 <br /> 06- <br /> o:3 A <br /> o5A 1033 <br /> 12-r,2 As 6 Cr torr !Q <br /> 0-7AB <br /> 6 07 <br /> A 597 - 5-0 <br /> +1� <br /> 1 �,•4� <br /> I ZA3 Q7 x nz <br /> Relinquished by DATE TIME Received by DAT TIME <br /> (Signature) C-6 :Z (Signature) ' 6 7 _ a� <br /> Relinquished by D TE TIM Received by DATE TIME <br /> (Signature) 9` �� f j •IF (Signature) <br /> 'E� �l6 g7 I S :4,v <br /> Relinquished by DATE TIME Received by DATE TIME <br /> (Signature) (Signature) <br /> Method of Shipment Lab Comments <br /> k <br /> 'Sample type(Specify) 1)37mm 0 8}gym MCEF 2)25mrn 0 8 Nm MCEF 3)25mm 0 4 Nm polycarb filter <br /> 4)PVC filler, diam pore size 5)Charcoal tube 6)Silica gel tube 7)Water 8)Soil 9)Bulk Sample <br /> 10)Other_ 11)Other <br /> COPIES WHITE JOB FILE YELLOW PROJECT FILE PINK CLIENT <br />