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Reporting tnfor > _ <br /> f Client C A S` e-0 C5 X;l e American Environment etwork ['SEN Page—* of <br /> "" 3440 Vincent Road,Pleasant Hill,CA 94523 <br /> Address / �1/CS REQUEST FOR ANALYSIS/CHAIN OF CUSTODY <br /> Phone(510)930-9090 <br /> Contact -J QVL4 Se.Y FAX(510)930-0256 Lab Job Number <br /> Alt ContactO ��GrU^^K Lab Destination e4Se� <br /> Date Samples Shipped 037-09W <br /> Address Report To Send Invoice To Lab Contact t k S <br /> 23 Date Results Required S d a <br /> Sail. GZS OAo Date Report Required , <br /> Client Phone No 7.09 - - fig`2ZZ <br /> Client FAX No ZO 9 - 57V-z2z <br /> ANALYSIS <br /> Send Report To 1 or 2 (Circle one) <br /> PPI(-GGUOt-ems GtTQ 0otfr3 (OZ61AI-t'MI <br /> Client P 0 No Client Protect I D No <br /> Sample Team Member(s) lq LE>< '7FUD*.-S <br /> Lab Client Sample Air Cate/ Sample No Type NIZY <br /> Number Identification Volume <br /> Time Typex Pres of off <br /> Collected Cont Cont is Comments/Hazards <br /> - 03M9 113) 7 H ��as5 t/ ,/ r_A je oXt er+ S <br /> A)w-3 1Z5 I/ TpwrE ova 260 <br /> u�- L4 r ✓ <br /> i ✓ # <br /> Relinquished by ^1- DATE TIME Received by DATE _ TIM <br /> (Signature) jQ Aev, o390 �' (Signature) - -3 -24- 7'25/ <br /> Relinquished by DATE TIME Received by DATE TIME <br /> (Signature) (Signature) <br /> Relinquished by t DATE TIME Received by DATE TIME <br /> (Signature) (Signature) <br /> Signature) <br /> Method of Shipment Lab Comments <br /> < i <br /> 'Sample type(Specify) 1)37mm 0 8 pm MCEF 2)25mm o 8 pm MCEF 3)25mm 0 4 pm polycarb filter <br /> ,-'4)PVC filter diam pore size 5)Charcoal tube'36)Silica gel tube 7)Water 8)Soil 9)Bulk Sample <br /> 10)other 11)*er, <br /> COPIES WHITE JOB FILE YELLOW4�PROJECT FILE PINK CLIENT <br /> 3�u <br />