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I Client JLICKLAND PROPEPTIES "'""' L,J,V&J'wi,IL4./L!L&L AVf-tVvv/n 1 JiLA-J1 I Page 6f L_ <br /> Address1A .K 13648 3440 Vincent Road Pleasant Hill, 523 REQUEST FOR ANALYSIS/CHA CUSTODY <br /> A M E,N T O , CA 95853 -4648 Phone(510)930-9090 <br /> Contact _JOHN MARGOWSKI FAX(510)930-0256 Lab Job Number <br /> Alt Contact Lab Destination <br /> Dale Samples Shipped <br /> Address Report To Send Invoice To Lab Contact <br /> Date Results Required <br /> 2 WESTERN GEO--ENGINEERS 3 SAME AS #1 Date Report Required <br /> 1386 E- E R S T R E E T Client Phone No - <br /> j wonnT.ANT) . rA,_ g577F—Anal� <br /> Client FAX No <br /> i <br /> ANALYSIS <br /> Send Report To 1 or 2 (Circle one) <br /> J 3 Grp <br /> Client P O No Client Protect I D No <br /> Sample Team Member(s) l�dG� yN <br /> Lab Client Sample Air Date/ Sample No Type v �+ <br /> Number Identification Volume Time Type, Fres of of <br /> Collected Cont Cont A, � Comments 1 Hazards <br /> L1246ft,12Z. <br /> lzx <br /> , <br /> I <br /> i <br /> Relinquished by �— DATE TIME Received by �. ! DATE TIME <br /> (Signature} "' -'Q7 1l:2 f'' (Signature) <br /> Relinquished by DATE TIME Received by DATE TIME <br /> (Signature) <br /> (Signature) <br /> Relinquished by DATE TIME Received by DATE TIME <br /> (Signature) (Signature) <br /> Method of Shipment Lab Comments <br /> r <br /> 'Sample type(Specify) 1)37mm 0 8 pm MCEF 2)25mm 0 8 pm MCEF 3)25mm 0 4 pm polycarb filter <br /> I <br /> 4}PVC filter, dram __ 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 /> I <br />