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Reporting Inh-ANIL H00A w <br /> 1 Client / rc� !o f Y Anter ican !nvu C1df171'ent C'twoi k AE ■ Page 0 <br /> Address a✓ 6 3440 Vincent Phone <br /> ( 10)91int Hill CA 94523 REQUEST FOR ANALYSIS/CHAIN OF CUSTODY <br /> /0 `�-� qCer<� �honc(5[tl}93p 9090 D <br /> Contact VAX(S 10)91(}0256 Lab Sob Number <br /> Alt Contact Lab Destination <br /> Date Samples Shipped <br /> Address Report To Set)d Invoice To Lab Contact <br /> Date Results Required <br /> 2 ' N 3 � Date deport Required <br /> ' - - - - - Client Phone No <br /> / - F �/51 Chent FAX No <br /> t rlteitt' <br /> ANALYSIS <br /> Send Report To 1 or(2 Cncle one) �G <br /> Client P O No Chent Protect I D No <br /> Sample Team Member(s) t <br /> i <br /> Time <br /> Pres of of <br /> Lab Client Sample hr Tel Sample �° Type <br /> Number Identification Volume Tme Type. <br /> Collected Cont Cont Comments/ Hazards <br /> 744. <br /> E <br /> t � <br /> r <br /> Relinquished by l DATE TIME Received by TIME <br /> (Signature) I(�%l O (Signature) Q <br /> Relinquished by �- Ji li DATE TIME Received by DATE TIME 1 <br /> (Signature} J(Y', � /fir �, �( j�� �L�<� // `rG (Signature) 3-2-q-2 //,1d <br /> Relinquished by DATE TIME Received by DATE TIME <br /> (S,gnature) (Signature) <br /> Method of Shipment Lab Comments <br /> *Sample type(Specify) 1)37mm 0 8 Vm MCEF 2)25mm o 8 um MCEF 3)25mm 0 4 Nm polycarb filter <br /> 4)PVC filter, dram pore size 5)Charcoal tube 6)Silica gel tube 7)Water 8)Soil 9)Bulk Sample <br /> 10)Other 11)Other <br /> COPIES WHITE JOB FILE YELLOW PROJECT FILE PINS( CLIENT -- - - <br />