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i ! <br /> Repori+ng inlorm� ,( � <br /> t, Client WICKLAND_PRORERTII;S Amey burr Envii onniental Nelmlol k AEN -�� Pago—� of <br /> Address _P.Q. Box 13648 3440 Vincent Raid,Pleasant Hill,CA 94523 REQUEST FOR ANALYSIS I CHAIN OF CUSTODY <br /> xammato. CA 53_--46 8 Phonc(5 10)930-9090 <br /> Contact John 41rgowski, 1 AX(510)930-0256 Lob Job Number, <br /> All.Contact Lab Destination <br /> Dale Samplos Shipped <br /> Address Report To: Sand Invoice To Lab Contact: <br /> Z Western Geo—Engineers 3, Data Results Required <br /> me As #1 ` <br /> 1386 E. Beamer Street Date Report RequiredNoont>?hone <br /> Woodland, CA 95776-6003 CClllient FAX Noe <br /> Send Report To t or 2 (Clrcia one) <br /> r ANALYSIS <br /> Client P 0 No Client Protect I D No D_3 Cr <br /> Sample Team Member(s) m C4 h r 1'r?0,( �\ � L1 <br /> Lab Client Sample Air Dale/ <br /> Sample N0 Type C . <br /> Number Indenlrficatton Volume of of <br /> Collected Type Fres Cant Conl ~ Comments!Hazards <br /> �t y,l t2-10-9 !d Z 7 ��cL zyaS L/ _ ' <br /> W Ira 51 r� <br /> 03 �w o � — <br /> �p Mw _ i2 yn �--- — <br /> 0� w r f let <br /> Relinquished by DATE ! TIME; ceived by D TE �d TIME <br /> E <br /> (Slgnalure) �r Ignaluro) <br /> Relinquished by AT E /IME Received by DATE TIME <br /> (Signature) (Signature) (� ( Z-� �-c ( ]� a <br /> Relinquished by AT TIME Received by DATE TIME <br /> (Srgnaturo) (Signature) <br /> Method of Shipment Lab Comments + <br /> 1 <br /> 'Sample typo(Specify) 1)37mm 0 8 pm MCEF 2)25mm 0 8 pm MCEF 3)25mm 0 4 pm polycarb tiller <br /> 4)PVC ldtor, dram pore size 5)Charcoal tuba 6)Silica gal tube tor 8)Soil 9)[luck Sample <br /> 10)Othar It)Olhor �1 <br /> COPIES Wnf1E JOG F0.E YELLOW PROJECT FILE PINK CLIENT i <br /> I <br />