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Reporting lnior <br /> 0 <br /> 1 Client C N PR ERTIES Anicl kern Envu onnzcllta ctwork AE-N <br /> Address 1 648 3440 Vulcent Road,Plcmanl lil[I,CA 94523 Nage� of <br /> 3-46 8 Phone(510)930-9090 REQUEST FOR ANALYSIS I CHAIN OF CUSTODY <br /> Contact John M owakz f AX(510)930-0256 Lab Job dumber <br /> All.Contact tab Destination <br /> Address Report To (:9gDale Samplos Shipped <br /> a +e; Send Invoice To Lab Contact <br /> Western Geo—Engineers sDate Results Required <br /> me As l}1 I <br /> 1386 E. Beamer Street Date Report Required <br /> Woodland, CA 95776-6003 Client Phone No <br /> Client FAX No <br /> Send Report To 1 or 2 (Circle one) ANALYSIS <br /> Client P 0 No Own:Project 1 D No <br /> Sampte Team Member(s) � /Y)G fi T ,��nn,C `r <br /> Q <br /> Lab Chent sample Air Date! Sam 1e No Type ' <br /> Number Indentrrcalion Volume Time Type Pros of of h <br /> Collected Conl. Cont. Comments 1 Hazards <br /> W l2-117-°! 10 ?J iter- ? troSS t/ <br /> M IV 3 —- I� <br /> w _ � <br /> w io �_ -� <br /> w, t2— q <br /> Relinquished by DATE TIME <br /> {Signature} Received by DATE TIME <br /> Relinquished by DATE TIME (Signature) <br /> (Signature) Received by DATE TIME <br /> (Signature) <br /> r;oGnquished by DATE T1ME <br /> (Signature) Received by DATE TIME <br /> Method of Shipment (Signature) <br /> Y. Lab Comments <br /> 'Sample typo(Speedy) 1)37mm 0 a pm MCEF 2)25mm 0 a pm MCEF 3)25mm 0 4 pm polycarb lillor <br /> 11)PVC It11er, diam pore size 5)Charcoal tube 6)Silica gel lube {T1Water 8)Sod 9)Oulk Sample <br /> t <br /> to)Other 11)Other <br /> COPIES WIME•JOaFILE YELLOW PfiOJECTFU PINK CLIENT <br />