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rte - 11 l"r of MP 1 —� <br /> Addy ": 3440 Vincent Road,Pleasant Hill,CA 94523 <br /> --- - ----- -- r r REQUEST FOR ANALYSIS/CHAIN OF CUSTODY <br /> Contact: <br /> I'hon�(510))30-10)0 <br /> — FAX(510)930-0256 Lab Job Number: <br /> �� <br /> 1S i LL__i_�1�13[%L�Ej_—___— <br /> All Conlact: _KC)$.tt�. .yBJ~ _-- Lab Destination: <br /> Date Samples Shipped: k/t g l G F� <br /> Addruss Report To: Send Invoice To: Lab Contact: <br /> 2. __— ! 3 Date Results Required: STAN(1ClR T7 <br /> --- � Date Report Required: -, <br /> - ---- -- _ Client Phone No.: <br /> - ---- — — — Client FAX No.: <br /> Sand Hepoa Tu:cL0 or 2 (Circle one) — — <br /> ANALYSIS RECEIVED <br /> Cham P.O.No.:-_i-C'f► 2= +_____-. Client Project I.D.No.: _.C- 7- i_ DEC y J 8 Inn` <br /> Sample Team Member(s) u 1 JU <br /> m GEOMAT IXCoNsutIANIS <br /> Date/ No. Type FRESw <br /> Number l <br /> Lab Client Sample Air Sample Pres. of of � <br /> Identification Volume Collected Type Cont. Cont. <br /> Comments/Hazards <br /> G<>r_.n _1—s.a <br /> M <br /> Relinquished by: DATE TIME RecDAT TIME <br /> (Signature) ' �� ' �3 �Relhiquished by: DATE TIME RecDATE TIME <br /> (Signature) (Sig <br /> Relinquished by: DATE TIME Received by: DATE TIME <br /> (Signature) <br /> (Signalun..) <br /> Method of Shipment Lab Comments <br /> 'Sample type(Specify): 1)37mm 0.8 pm MCEF 2)25mm 0.8 pm MCEF 3)25mm 0.4 pm olycarb.filter <br /> 4)PVC filter, diam. pore size _ 5)Charcoal tube 6)Silica gel tube 7)Water8)Soil. 9)Bulk Sample <br /> 10)Olhu(.. ---.__.. . .. 1 1)0111or <br /> COPIES. WHITE•JOn Hl E YLI LOW-PHOJEC I FILE PINK-CLIENT <br />