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Reporting Infor "'t"—u <br /> PkFK 1Pge of <br /> American Envirvnrt�efzt etwvrk A EN <br /> 1 Client / r i(S`�f�G14t c 5 T s ` <br /> 3440 Vincent Road Pleawt Hill,CA 94523 <br /> Address li f, �n 11��� iREQUEST FOR ANALYSIS 1 CHAIN OF CUSTODY <br /> Phone(510)910-9090 Y <br /> Contact —Jr o tse - FAX(510)930-0256 Lab Job Number <br /> �� {- �� �� Lab Destination <br /> All Contact eQ5Q1) 1a <br /> l-4 Date Samples Shipped 5 3 7 p g g <br /> Address Report To Send Invoice To Lab Contact <br /> -2 Date Results Required Sr d -rAT 7 - <br /> 2 <br /> Ct CL�rrsJe. 3 �Ccsv�s2 Date Report Required J <br /> _ Client Phone No Z09 - 579 Z <br /> Client FAX No Zo q ` 57 GZZS <br /> ANALYSIS <br /> Send Report To 1 or 2 (Circle one) <br /> Client P O No Client Project I D No ow <br /> Sample Team Member(s) <br /> Lab Client Sample Air Date/ Sample No Type <br /> Number Identification Volume Time Type, Ptes of of ,4 <br /> Collected Cont Cant Comments/Hazards <br /> l A, r �t ti11 - t -7 HCA Cr bass 1/ li dX+ of-1eJ s <br /> -7A_ - P ,�i l z 3 ✓ T�3A mraC bIPt <br /> �I-r- A1 <V7`,4A46_ ole G <br /> 1345 7 V <br /> r f,,AlrJ 30 V, <br /> _ A .A1r)i,} € <br /> 14 <br /> Relinquished by DATE TIME Received by DATE TIM <br /> �y (Signature) <br /> (Signature) 7� , psi_. G�37Q96 1 � _ <br /> DATE TIME DATE TIME <br /> AZ <br /> Relinquished by } ,' Received by <br /> (Signature) k (} 0G (Signature) zp-9 fC-S <br /> Relinquished by DATE TIME Received by DATE TIME <br /> (Signature) (Signature) <br /> Method of Shipment Lab Comments <br /> 'Sample type(Specify) 1)37mm 0 8 pm MCf F 2)25mm 0 8 pm MCEF 3)25mm 0 4 pm polycarb filter <br /> 4)PVC filter, diam pore size 5)Charcoal tube 76)Silica gel tube 7)Water 8)Soil 9)Bulk Sample <br /> 10)Other _ 11} r ` f <br /> COPIES WHITE JOB FII f YELLOW F1oiECT FILE PINK CLIENT <br />