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Reporting Informatilft <br /> 1 Client Wpe <br /> �AND PROPERTIES Arnereccin Envlroninental peork Page <br /> Address -E,-O. BQN 13648 3440 Vincent Road,Pleasant Hill,CA 94523 <br /> 3AC RA ME N TO , CA 95853 .4648 Phone(510)930-9090 REQUEST FOR ANALYSIS/CHAIN OF CUSTODY <br /> Contact N MARGOWS K I FAX(510)930-0256 Lab Job Number <br /> Aft Contact Lab Destination <br /> Date Samples Shipped <br /> Address Report To Send Invoice To Lab Contact <br /> 2 WESTERN GEO-ENGINEERS 3 SAME AS 1 Date Results Required <br /> 11R.6 F. BEA�IEEDate Report Required_ STREET Client Phone No - <br /> { — Client FAX No <br /> Send Report To 1 or ANALYSIS <br /> p (Circle one) � �] <br /> Client P O No Client Project I D No !` L l= 3 <br /> t <br /> Sample Team Member(s) _M�i�'� Pen,CA >y <br /> b <br /> Lab Client Sample Air Date/ Sam le No Type <br /> Number Identification Volume Time TypePres Of of <br /> Collected yp Cont Cont Comments/Hazards <br /> ' 'g-17 l B9 <br /> Relinquished by 4DA <br /> TIME Received b <br /> (Signature) �- (Slgnature)y �� �Relinquished b TIME Received b �V <br /> (Signature) Y DATE TIME <br /> (Signature) <br /> Relinquisby DATE TIME Received by DATE TIME <br /> I (Signature (Signature) <br /> Method of Shipment Lab Comments J <br /> 'Sample type(Specify) 1)37mm 0 8 pm MCEF 2)25mm 0 a um MCEF 3)25mm 0 4 pm polycarb filter <br /> 4)PVC filter diam pore size 5)Charcoal tube 6)Silica get tube 7)Water 8)Soil 9)Bulk Sample <br /> 10)Olher_&_r 11)Other <br /> I <br /> COPIES WHITE JOB FILE YELLOW PROJECT FILE PUNK CLIENT <br />