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UIETZ ENGINEERING AND CONSTRUCTION, INC, CHAIN OF CUSTODY / <br /> Transmit;results to offlce clreclted below: REQUEST FOR ANALYSIS <br /> 33233 South Koster Road,Tracy, CA 95304 RECORD ` 2 G o 6 I I <br /> Voice: (209)832.2910 Fax: (209)833-1288 / <br /> ❑ 1120 Hollywood Ave, No, 3, Oakland, CA 94602Laboratory: C�_��:! -c"4 <br /> Voice(510)336.9118 Fax: (510)336-9119 Carrier, <br /> Prpject; Wayblll No,; <br /> Project No,; ProJeot Mgr, <br /> Sampling Team; 7� ZT% c� <br /> Site Global LD, No,: <br /> 'Sample Type Field 'Worlboodl Dopthto Date Time Analyses Requested Lab,No, <br /> Niunber Palgt Surf,Elov, GW/sample Sampled Snmplod <br /> Crn Z _Q <br /> i <br /> Sample Hazards: Priority: Routine Expedited ❑ Special ❑ <br /> Notes: <br /> CUSTODY RECORD Print Name Com an Date Received TlmeRecelved Data el uished TlmeRolin ulshed Si unture <br /> Originator, E�C� 6 <br /> Received/Relinquished by: . S <br /> Raoelvedl Relinqulshad by: <br /> Received/Relinquisher!by,- <br /> Received <br /> y:Received at Laboratory by: <br /> , <br /> Ray,0/0 <br />