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a-- <br /> parting Inlorrnalion: AEN <br /> f / <br /> WICKLAND PROPERTIES �»IC)tCtt1l E1tVtl"Oltlltt?IllCtl Net*- ��i.�,[ �' Faflo ,L_� 0AIL <br /> ClieAddress: <br /> 3440 Vincent Road,Pleasant Hill,CA 94523 <br /> /tddress: P,�S?��-max_1 364 B Picone St0 930-909(1 REQUEST FOR ANALYSIS�CHAIN QFC QDY <br /> ,�CRAMENTO,, CA 95853 -4648 ) <br /> Contact FAX(510)930-0256 Lab Job Number: �� �•�2-`�R <br /> Alt Conlact: Lab Destination, <br /> Date Samples Shipped:Idtess Report To: Send Invoice To: Lab Contact: <br /> hate Flesults Required: <br /> • Yt STERN GED-ENGINEERS <br /> — -SAKE-AS #_t _ _. Dale Report Required: <br /> - IA06- E- MEAMER STREET Client Phone No.: <br /> Client FAX No.: — <br /> . ANALYSIS <br /> iend Report To: 1 or 2 (Circle one) k �, <br /> ;Gaal P.D.No, Client Project I.D.No <br /> GD.3 ar <br /> Sample Team Member(s) M�2,t1- PZ122 i IZ C +, <br /> Lab Client Sample Air Date/ Sample No. <br /> Number Identification Volume Time Type) Ates. of of � �� Comments/Hazards <br /> Collected Coni. Cont <br /> /,2-f7- ICL Vo _ <br /> 6' 12-17 I� ►� �/ 1 <br /> �,�✓ - -- -_ 5V& 7 ✓ ✓ — -- <br /> rtcv - Z 12-/6. t r: o d J <br /> 1� 1) ' L0. .10? Ly <br /> 4 - 9 l 12-I S7 1/ ' 5 ' d I <br /> b7 <br /> 12- -17 i.7 1 1. I r' ✓ ✓ <br /> Relinquished by: DATE TI E tleceived by: DATE TIME <br /> (Slgnalure) /�.��_ Y y ` <br /> (Signalure) `I2-/ -9. l Z;0 <br /> Relinquished by: DATE TIME Received by: CATE TIME <br /> (Signature) f 2 ! (Signature) t !3 I <br /> Relinquished by: GATE TIME Received by: DATE TIME <br /> (Signature) (Signature) <br /> Method of Shipment Lab Comments <br /> 'Sample type(Specify): 1)37mm 0.8 irm MCEF 2)25mm O.tl pm MCEF 3)25mrn t1.4 pm polycarb.filter <br /> 4)PVC filter, diaM. pore sixo 5)Charcoal tube G)Silica gel tube e Water 0)Soil 9)Bulk Sample <br /> To)Ottret t t)Other <br /> COPIES: MOTE•JOB FILE YELLOW•PnOJECT FILE PINK-CLIVIT <br />