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1. Client: {•I 1�Y11JL�4`Q.(� GI►DVD. to 1L- �11ZG1'lL'Uil e:�dVl1 Vr�lydc ►dtc�L Svc cVVvl�� 1 Ir'� SIS" N, Page 1 of <br /> � X1. <br /> Address: L 'n'410 3440 Vincent Road,Pleasant Hill,CA 94523 REQUEST FOR ANALYSIS/CHAIN OF CUSTODY <br /> �- 6-0 Phone(510)930-9090 Sv 5 a--- <br /> Contact: ?�+ l-y FAX(510)930-0256 Lab Job Number: _ <br /> All.Contact;, cr rXct S WidlOLh 4-k— Lab Destination: <br /> Date Samples Shipped: <br /> Address Report To: Send Invoice To: Lab Contact: <br /> / Date Results Required: ��u` - Ct C((' <br /> 2' l l ] f'a<Cc.N 77 LVC #/L1 Date Report Requlred: <br /> A'1114 111MY1`h C4 Client Phone No.: <br /> Client FAX No.: f ,� 5)Z J i <br /> ANALYSIS <br /> Send Report To: 1 or 2 (Circle one) t ..— <br /> Client P.O.No.: Client Project I.D.No.: (O <br /> pie Team Member(s) <br /> YP <br /> Lab Client Sample Air Dale/ Sample No. Type <br /> Number Identification Volume Collected cted TYPe' Pres. Cont.f of <br /> Cont. Comments 1 Hazards <br /> DIA-c- <br /> 03A- —_5 <br /> ri a <br /> I 1 P <br /> o� I <br /> 5-1 <br /> Relinquished by. _ DATE TIME Received by: �,, DATE TIME <br /> (Signature) �� ;� . Z{� (Signature) <br /> Relinquished by: DOE TIME Received by- DA E TIME <br /> (Signature) �" �FC7kJ (signature) " <br /> Relinquished by: DATE TIME Received by: DATE TIME <br /> {Signature) (Signature) <br /> Method of Shipment Lab Comments <br /> i <br /> 'Sample type(Specify): 1)37mm 0.8 pm MCEF 2)25mm 0.8 pm MCEF 3)25mm 0.4 um polycarb.filter <br /> 4)PVC filter, diam. pore size 5)Charcoal t be 6)Silica gel tube 7)Water 8)Soil 9)Bulk Sample <br /> 10)Other iher <br /> — PIES:M161: <br /> I F. B FI <br /> -JOLE— YELO -PWICT 1 PINK-J& — <br />