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Aeporiing Intorma A ]�� i <br /> 1. Client: <br /> WICKLAND PROPERTIES American �llVll-OfI111C11lQltorVIC �1�1Y Paga� of <br /> Address: E-0- Box 13648 3440 Vinccnt Road,Plcasant Hill,CA 94523 REQUEST FOR ANALYSIS 1 CHAIN OF CUSTODY <br />( 9585314648 Phone(5 10)930-9090 <br /> Contact: JOHN N_M$RG!DWS K I FAX(510)930-0256 Lab Job Number: <br /> An Contac: Lab Destination: <br /> Data Samples Shipped: <br /> Address Report 7o: Send Invoice To: Lab Contact: <br /> 2. WESTERN GEO-ENGINEERS 3. Date Results Required: <br /> _ SAME AS #1 Date Report Required: <br /> 1 jRA__E_ 13EAMER S I`BNEX Client Phone No.: <br /> WOODI.ANT) CA g577A_Hnni Client FAX No.: <br /> ANALYSIS <br /> Send Report To: l or 2 (Circle one) �•, <br /> Client P.O.No.: Client Project I.D.No.: AL-60-.31 <br /> 1 6O a <br /> r `C <br /> Sample Team Member(s) ,����J* -pr71 r�Z ^^ 41 <br /> Lab Client Sample Air Dale! Sample Pres. oo. Toe <br /> Number Identifikation Volume Time ' Q+ Comments!Hazards <br /> Type* Cont Cont. <br /> 12-17-Y7 12:16 lict 5 ffo <br /> W 2 /2 17` 12:5 ✓ <br /> J2-17-27 2.177 41 J _ <br /> 12.I6_ ✓ _7 <br /> - G �,�-1. � � ✓ J <br /> Mw - 7 12-I61La d <br /> 12-17-2 /0 'S ✓ <br /> M IV I -77 S ' J J I <br /> - r 0 /z•17.y 7 2 : 50 J J ✓ <br /> /li - I r2 -(7- 4 J J <br /> - 1 2-17.J7 . 161.,251 <br /> I2-17-i7 l: 4 G <br /> I2- 17-971 3 12 1 4— <br /> J ✓ <br /> Relinquished by. DATE TIME Received by. DATE TIME <br /> ign <br /> (Sature) /2./ -y /2-:0 (Signature) lea /2=o7 <br /> Rekquished by: DATE TIME Received by: DATE TIME <br /> (Signature) (Signature) <br /> Reed by. DATE TIME Received by. DATE, TIME <br /> (Signature) (Signature) <br /> Method of Shipment Lab Comments <br /> 'Sampto type(Specify): 1)37mm 0.8 pm MCEF 2)25mm 0.8 pm MCEF 3)25mm 0.4 ym polycarb.filter <br /> 4)PVC filter, diam. pore size 5)Charcoal tube 6)Silica gel tube DWaler 8)Soil 9)Bulk Sampte <br /> 10)Other 11)Other <br /> COPIES: WI11TE-J00 FILE YELLOW-PROJECT FILL: PINK-CLIENT <br />