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r. uient• W ND 1?R ERTx£S I`t171C1 1LCl1z L"vii U77>11eiiial Ncivi)0/kAE N <br /> Addressa T 648_x_ 3440 Vulccnt Road,Ple.LIant Ifill,CA 94523 Pago�_ of L <br /> —46,18 Phonc(510)930.9090 !�%.3 5 REQUEST F-OR ANALYSIS/CHAIN <br /> Conlact• John M owakI, OF CUSTODY(5I0)930-0256 q7t� <br /> All.Contact- Lab Job Number _ 'j.3 a <br /> Lab Destination <br /> Address Reporl To- Date Samples Shipped�Send invoice To <br /> 2 Geo--Engineers <br /> Lab Contact. <br /> Lab 3 — —�--� <br /> me As it T Date Results Required <br /> 1386 >r. Beamer Stz•eely L Data Roper;Requiredi �' <br /> Woodland, Ch 95776-60 .3 Client Phone No• �� <br /> Client FAX No <br /> Send Report To I or 2 (Circle one) -0------------------——--- <br /> ANALYSIS <br /> Client P 0 No Client Project 10 No [ <br /> Sample Team Member(s) `lj <br /> Lab Client SampleDale/ <br /> Number �a <br /> Indenlifcatlon Volume <br /> it Collected TYPeIe Pres No0 Typo <br /> Cant. Can[, <br /> 56 7 HSL 2 Vp Cctmmenls/Hazards <br /> 03 <br /> '• a ✓7 z6 r <br /> 0 <br /> Relinquished by DATE TIME <br /> (Signature) Zy 7 Recelvod by DATE TIM <br /> Relinquished b 0` Z (Sionaturo) ,(�� �� <br /> (Signature) Y DATE _ TIMI; Received /' «�1 -29 � <br /> Bolin :shod b —2 �'`S (Slonaluro) 9DATE TIME <br /> Ru Y DATE TIME r_—J L/ /I� <br /> (Signature} Recolvod by DAT[ TIME <br /> Method of Shipment (sipnalure) <br /> Ir. Lab Comments <br /> Sample typo(Specify) 1)37mm 0 0 pet MCEF 2)25mm 0 0 pm MCEF 3)25mm 0 4 pm Polycarb filter ----- <br /> 4)PVC filter diam Pore size 5)Charcoal tubo G}Silica flet Tubo Sa <br /> ThWater ft)Sad 9)DUNDUNmple <br /> 10)Other 1 t)Other VVJJ <br /> • COPICS WIIIIE JOOFtLL YELLOW-PnOJECTFILE PINK CLIENT <br /> r <br />