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Reporting Inform -x; <br /> 1. creat: Assnc.lcd-cr, American Environments;;:::; ,etwork AEN Page of <br /> Address: 1`L ( r , 3440 Vincent Road,Pleasant Hill,(A 94523 REQUEST FOR ANALYSIS 1 CHAIN IOF CUSTODY <br /> Phone(510)930-9090 <br /> Contact: w = wse-'l FAX(510)930-0256 Lab Job Number: <br /> All Contact: rt)I'V, Lt.y�ke.K l ati� Lab Destination: <br /> Date Samples Shipped: _ <br /> Address Report To: Send Invoice To: Lab Contact: <br /> 2 3-n t` Date Results Required: -7C N y g ._(�S'Oaf C <br /> ��.�..t.s.. G S CJl � <br /> Date Report Required: <br /> Client Phone No.: 0 q- 7 - r7 <br /> Client FAX No.: - —971- r?Z 5 <br /> Send Report To: f 1 )or 2 (Circle one) ANALYSIS <br /> Client P.O. No.: C��� r Uot 113 Client Project I.Q.No.: 1 VGA - C?cc) ~ <br /> Sample Team Member(s) f K U { 5_ <br /> Lab Client Sample Air Date/ Sample Pres. of Tope <br /> Number Identification Volume Time Collected Type* Cont, Cont. Comments/ Hazards <br /> t'Aw- 037 r - '7 NLS i',,SS ( � tar, mi S <br /> ti�1t� 2 )Do -7 Ll {� U P P k q04 C QS �js1C1 <br /> rvr*o �1 3 v 0.6 -T -x . <br /> 1>f Q{VidC, Co o'e <br /> 0411tri <br /> .7 <br /> Relinquished by: - I DATE TIME Received by: l DATE TIME <br /> (Signature) C r^af� ��t � r) `, �) j (Signature) <br /> Relinquished by. DATE TIME Received by: DATE TIME <br /> (Signature) (Signature) <br /> Relinquished by: DAl E TIME Received by: DATE TIME <br /> (Signature) (Signature) <br /> Method of Shipment Lab comments <br /> 'Sample type(Specify): 1)37mm 0.8 pm MCEF 2)25mm 0.8}im MCEF 3)25mm 0.4 um polycarb.filter <br /> 4)PVC filter, diam. 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 PINK-CLIENT <br />