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}leporting Informal& <br /> A�NI Client 1. ��K� k �. rS AiYIGi"1CQ12 E12Vli"012YYICYI�Q DYk <br /> Page f I� <br /> Address 3440 Vincent Road,Pleasant Hill,CA 94523 REQUEST FOR ANALYSIS/CHAIN OF CUSTODY <br /> Phone(510)930-9090 <br /> Contact n _ 4�SG-fir,' FAX(510)930-0256 3�5 Lab Job Number C� 4 <br /> Alt Contact 1 5 _A Lab Destination , <br /> ' Date Samples Shipped <br /> Address Report To Send Invoice To Lab Contact <br /> p 3 Date Results Require57 4 11 D4P. <br /> d <br /> Date Report Required <br /> 6 /- rc• <br /> _ Client Phone No <br /> Client FAX No ' <br />' Send Report To 1 or 2 (Circle one) <br /> ANALYSIS <br /> Client P O No Client Project I D Na o 3 t k <br /> Sample Team Member(s) ± •5�t- r <br /> Lab Client Sample Air Date/ Sample prey of Type <br /> Number Identification Volume C llected Time Type Cont Cont f` Comments/Hazards <br /> Ic CLQ <br /> Relinquished by / DATE TIME Received by DATE TIME <br /> (Signature) q /,--,- r- (signature) t = -?S <br /> Relinquished by DATE <br /> (Signature) TIME Received by DATE TIME <br /> (Signature) <br /> Relinquished b,", DATE TIME Received by DATE TIME <br /> (Signature) (Signature) <br /> Method of Shipment Lab Comments <br /> 'Sample type(Specify) 1)37mm o 8 pm MCEF 2)25mm 0 8 pm MCEF 3)25mm 0 4 pm polycarb filter <br /> 4 PVC filter, dram ' <br /> pore size 5)Charcoal tube 6}Silica gel tube 7)Water 8)Soil 9)Etullc Sample <br /> 10)Other 11)Other <br /> COPIES WHITE JOB FILE YELLOW PROJECT FILE PINK CLIENT <br />