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Reporting lnfor <br /> 0 <br /> 1 Client AND ER ES +'71C1'ICQJI4.JIVJJ'UlIJIICJIIQ C1work AEN <br /> Address 48 <br /> 3440 Vincent Road,Pleasant 11111,CA 94523 Page of <br /> 8 Phone(510)930-9090 REQUEST ICOR ANALYSIS J CHAIN OF CUSTODY <br /> Contact John Margowski, FAX(510)930-0256 Lab Job Number <br /> Aft Contact Lab Destination <br /> Address Report To Send InvoiceDale Samples Shipped <br /> To Lab Contact <br /> 2• Western Geo–Engineers 3 Date Results Required <br /> 1386 E. Beamer Street ��� As #i Date Report Required <br /> Woodland, CA 95776-6003 Client Phone No <br /> Client FAX No <br /> Send Report To I o 2 lrcle one) ANALYSIS , <br /> Client P O No Cilen Protect I D No 1 - (0 <br /> — O� <br /> Sample Team Member(s) <br /> Lab Client Sample Arr Dale/ Sample N0 �YPe - <br /> Number Indentllecalron Volume Time Type* Pres of o! <br /> Collecled YP Cont Corn Comments 1 Hazards <br /> .? 3w <br /> M <br /> kl-fo — �o <br /> l�•30 <br /> Relinquished by DATE TIME Receivod b <br /> (Signature) Y DATE <br /> TIME <br /> (Signature) _ a <br /> SiignRelianature)uished by DA E TIME Received b A TIME <br /> g (Signature) <br /> Relinquishedby DATE TIME Received b <br /> (Signature) (Signature)y HATE TIME <br /> Method of Shipment Lab Comments <br /> Y. <br /> 'Sample type(Specify) t)37mm 0 8 pm MCEF 2)25mm 0 8 pm MCEF 3)25mm 0 4 pm polycarb filter <br /> 4)PVC filter, diam pore size 5)Charcoal tube 6)Silica gel tube 7)Water 8)Soil 9)Bulk Sample <br /> • 10)Other I I IN)Other <br /> COPIES WHILE "FILE YE, r PnOJECT FILE PINK CLIENT <br />