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Reporting Informal C�{ Yr5� 5-3 <br /> 1 Client GLAND-PROPERTIES A1rj13!lculr En vu olrmental 9woi k AE <br /> Address x 13648 <br /> 3440 Vincent hold,Plcaeant Ilrll,CA 94523 Page of <br /> A 53-46 18 Phonc(510)930-9090 REQUEST FOR ANALYSIS!CHAIN OF CUSTODY <br /> Contact John MIU0waki I AX(510)930 0256 Lab Job Number Zr? <br /> Alt Contact Lab Destination <br /> Dale Samples Shipped <br /> Address Report To Send Invoice To Lab Contact: <br /> 2 Western Geo—Engineers 3 Dale Results Required <br /> Same As #1 Data Report Required <br /> 1386 C. Beamer Street <br /> Woodland, C:A 95776_6003 Client Phone No <br /> Client FAX No <br /> Send Report To 1 o 2 lrcle one) ANALYSIS . <br /> Client P O No CheriVrolect I D No <br /> Sample Team Member(s) V <br /> Lab Client sampleAir Date/ Sample No Type <br /> Number Indentrflcatlon Volume T e Pres of of <br /> Collected YP Cant Cont Comments!Hazards <br /> i s <br /> E <br /> — — <br /> A a <br /> Qr--,A 04 w-' _ <br /> w- /•o <br /> 91 W 9 =30 <br /> A N <br /> Relinquished by DATE TIME <br /> (Signature) Received by DATE TIME <br /> tT� <br /> (Signature} _ <br /> flelrnqurshed by DA E TIME Recelved bAT <br /> (Signature) 3 5� (S€gnaturel /-L- IME <br /> (Signature) DATE TIME <br /> 2i -Y� LO <br /> j <br /> (Signature) Received by DATE TIME <br /> (Signature) <br /> Method of Shipment Lab Comments <br /> 'Sample type(Specify) 1)37mm 0 8 Um MCEF 2)25mm 0 8 pm MCEF 3)25mm 0 4 pm polycarb Filter <br /> 4)PVC miler diam __._„ pare Size 5)Charcoal tubo 8)Silica get tube 7)Water 8)Soil 9)Burk Sample <br /> 10)Other— 11)Other <br /> COPIES WHITE JOB FrLE YELLOW PnOJECT FILE PINK CLIENT <br />