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rAddross <br /> ntorm <br /> C N RO ERT ES A111C1 1call E1I1111 U1111 ental oxioi k { <br /> A Pago -L al _ <br /> 1 648 �" J�14U Vmccnt Road,Pleasant Hdl,CA 94523 <br /> CA 95�4 6 p P11011c(510)930-9090 REQUEST FOR ANALYSIS!CHAIN OF CUSTODY <br /> john M owaki. rAX(510)930-0256 <br /> Lab Job Number <br /> tact Lab Destination . <br /> Address Report To Dale Samples Shipped <br /> f Send Invoice To Lab Contact <br /> 2- Western Geo—Engineers 0 F Date Results Roqulred <br /> 1366 E. Beamer Street '^ ��� Ar, ill <br /> .— Date Report Roqulrod <br /> Woodland, CA 95776-6043 Client Phone No <br /> Client FAX No ' <br /> -------------- <br /> Send Report To I or 2 (Circle one) ANALYSIS <br /> Client P O No Cltont Project 1 D No <br /> Sample Team Members <br /> Lab Dale/ <br /> Client Sample Sample Type ; <br /> Number lndenitftcallon Volume Time rYp�. Pres of oi !C <br /> Collected Cont Cors- Comments 1 Hazards <br /> �W L� 12-15--9 14 2 t�cc ' <br /> w /0 . 90 <br /> Mw 51 <br /> �r <br /> I <br /> F <br /> r <br /> Relinquished by DATE TIME Til <br /> (Signal Ire) _ ceivod by DgTE TIME <br /> Ignature) /f _A , <br /> Relinquished by D E TI E <br /> (Signature) Received by DATE TIME <br /> ' <br /> (Signature) <br /> Rodnqurshed by DATE TIME i <br /> (Signature) Rocolvod by DATE: TIME <br /> (Signature) 1 <br /> Method o!Shipment � <br /> t; Lab Commonts <br /> 'Samplo typo(Specify) 1)37mm 0 0 pm MCEF 2)25mm 0 e pm MCEF 3)2Smm 0 4 pm polycarb Filler i <br /> 4)PVC Idler, dram pore size 5)Charcoal tubo 6)Silica got tubo ator 0)Sol[ 9)Bulk Sampo F <br /> `i lr <br /> 10)Other 11)Other r <br /> COPIES W"ITE JOB FRE YELLOW PROJECT FILE PINK CLIENT <br />