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Reporting Intormati r <br /> T. H 1 Z r rs Awrican Environmental 41work AEN ` Page0 <br /> 1 Client ' 3440 Vincent Road,Pleasant Hill,CA 94523 <br /> Address Phone(510)930-9090 REQUEST FOR ANALYSIS 1 CHAIN OF CUSTODY <br /> dContact FAX(510)930-0256 Lab Job Number <br /> .`Alt Contact- Lab Destination <br /> Date Samples Shipped <br /> Address Report To Send Invoice To Lab Contact <br /> Date Results Required 51,d z34f)A" <br /> 2' f•G�`. sf C�•. fir;r °if- 3 !�` /"' Date Report Required <br /> Client Phone No <br /> r-7� — Client FAX No <br /> r <br /> ANALYSIS <br /> Send Report To 1 or 2 (Circle one) <br /> #,Client P O No Client Project I D No G 3 ` <br /> Sample Team Member(s) <br /> � f <br /> Date/ No Type h tJ <br /> Lab Client Sample Air Sample <br /> Number Identification Volume Time Collected Type" Pres Cont Cont. Comments/Hazards <br /> rf G�rF <br /> CLQ <br /> LYZ. <br /> r <br /> `tel <br /> ` Relinquished by _ / DATE TIME Received by DATE TIME <br /> (Signature) /= 9 /G 3 r'" (Signature) <br /> Pw Relinquished by DATE TIME Received by DATE TIME <br /> (Signature) (Signature) <br /> Relinquished by DATE TIME Received by DATE TIME <br /> (Signature) (Signature) <br /> ` Method of Shipment Lab Comments <br /> b <br /> "Sample type(Specify) 1)37mm 0 8 prn MCEF 2)25mm 0 8 um MCEF 3)25mm 0 4 Jim polycarb filter - <br /> 4)PVC filter, diam __ pore size 5)Charcoal tube 6)Silica gel tube 7)Water 8)Soil S)Bulk Sample <br /> b 1 O)Other 11)Other <br /> COPIES WHITE JOB FILE YELLOW PROJECT FILE PINK CLIENT \,4 — <br />