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Reporting In{orm* <br /> 10 <br /> 1 Client WICKLAND PROPERTIES AJJIL'J"ICQJt E12VJJOJIJ72e1ztGl et�t'OJk AEN <br /> Address B x 13648 <br /> 3440 Vincent Road,Pleasant Hill,CA 94523 page of <br /> .SACRAMENTO , CA-9.51353 -4648 Phone(510)930-9090 REQUEST FOR ANALYSIS J CHAIN[OF CUSTODY <br /> Contact —ZOHN MA)2G"aU FAX(510)930-0256 Lab Job Number - �}�o10Z6 <br /> Alt Contact Lab Destination <br /> Date Samples Shipped <br /> Address Report To Send Invoice To Lab Contact <br /> 2 WESTERN GEO—ENGINEERS 3 Date Results Required <br /> SAME AS #1 Date Report Required <br /> _1386 E. _ EB AMER STREET <br /> Client Phone No <br /> -� <br /> Client FAX No <br /> Send Report To 1 or 2 (Circle one) ANALYSIS <br /> Client P O No Client Project I D No V <br /> Sample Team Member(s) 13 cAV4 <br /> Lab Client Sample Air Date/ Sample No Type <br /> Number Identification Volume Time ePres of of <br /> WA Collected Type' Cont Cont Comments/Hazards <br /> Relinquished by DATE <br /> (Signature) ,�/ TI E ' Received by DATE TIM <br /> e —W—f7 (Signature) <br /> Relinquished by <br /> �D TE TIME ` -Received by DATE TIME <br /> (Signature) Y//�/ (Signature) <br /> Relinquished by DATE TIME <br /> (Signature) Received by DATE <br /> TIME <br /> Method of Shipment <br /> (Signature) <br /> Lab Comments <br /> 'Sample type(Specify) 1)37mm 0 8 pm MCEF 2 <br /> )25mm 0 8 pm MCEF 3)25mm 0 4 pm polycarb filter <br /> 4)PNC filler, dram pore size 5)Charcoal tube 6)Silica gel tube 7)Water 8)SOd 9)Bulk Sample <br /> 10)Other 11)Other <br /> PIES WHITE JOB FILE YELLOW PROJECT FILE PINK CLIENT <br />