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ffl" <br /> 6g+ <br /> 1 client "I �a� �,� American Enviranmer to tworknLON Page at <br /> Address g Z �sc'a... 3440 Vmcent•Road,Pleasant Hail,CA 94523 REQUEST FOR ANALYSIS/CHAIN OF CUSTODY', <br /> i Phone(5 10)930-9090 <br /> Contact _—re %:L�Z__. — FAX(510)930-0256 Lab Job Number <br /> Lab Destination <br /> i Alt Contact Date Samples Shipped I11� <br /> Address Report To = ; Send Invoice To Lab Contact [L b r <br /> �, r, • S Date Results Required __ __-I&av_ �+-�o. TAT <br /> 4 S... Date Report Required <br /> Client Phone No — a <br /> Client FAX No <br /> ANALYSIS rr <br /> Send Report To 1 or 2 (Circle one) " <br /> Client P 0 No _ +4 S ' �'�� 'Z Client Project 1 D No <br /> Sample Team Member(s) <br /> xX <br /> Lab r Client Sample �Ame <br /> 94 e Sample -�Bs ofTe ZNumber Identification Collected Type Cont Cant Comments/hazards <br /> 4 5 <br /> (I to as S-'l ( e-( ,21A <br /> 't,C) k <br /> W- 8- r S <br /> -G =- : (S <br /> nAA-e, - q <br /> Relinquished by „ DATE TIME Received by - DATE TIME <br /> (Signature) {1 Z s (a ( J (Signature) ,. <br /> Rellnqulshed b / DATE 'TIjUIE Received by DATE Tl E <br /> (Signature) / r /��' (Signature) f I`Z(-Zi <br /> Relinquished by DATE `' TIME Received by DATE M 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 Nm polycarb triter <br /> 1 f <br /> 4)PVC filter, dram pore size 5)Charcoal tube 6)Silica gel tube 7)Water 8)Soil 9)Bulk Samplo <br /> 10)Other 11)Other <br /> COPIES WHITE JOB FILE YELLOW PROJECT FILE PINK CLIENT <br />