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Reporting Informat, <br /> American Environmental AEN Page of <br /> 1. Client: <br /> Nt- 3440 Vincent Road,Pleasant Hill,CkW23 <br /> Address: Phone(510)930-9090 REQUEST FOR ANALYSIS CHAIN OFD <br /> .CUSTOY <br /> Contact: 144 eAFAX(510)930-0256 Lab Job Number: ?8033A-5_ <br /> - - -, Lab Destination: 'Ill, Ca <br /> Alt.Contact: Date Samples Shipped: �12, <br /> Address Report To: Send Invoice To: Lab Contact: A <br /> 3. Date Results Required: <br /> 2. ay 03+"Aw C <br /> w,L as Date Report Required: I V <br /> Client Phone No.: -2 0 9 �S r7 q ?-Z;Z-j <br /> Client FAX No-: 78c)-s- :29- z fl <br /> Send Report To:01or 2 (Circle one) ANALYSIS <br /> Client P.O.No.: &F'Fq 900146 Client Project I.D. No.: .. 06C)l <br /> Sample Team Member(s) — a I ex TL_0 ves RECEIVED APR 2 1 <br /> Lab Client Sample Air Date/ Sample No. Type LU <br /> Number Identification Volume Time Type* Pres. of of <br /> Collected Cont. Cont.. Comments I Hazards <br /> Ac tAV1J_ I <br /> L -7 _666,S jA t4 I <br /> I/ <br /> vlo <br /> A.V9 <br /> % <br /> Relinquished by: DATE TIME Received by: DATE TIME <br /> (Signature) '3Z�d�& <br /> /7 S-0 S- (Signature) <br /> Refinquished by: D T(V)E TIME Received by: DATE TIME <br /> ,�j_ Z <br /> (Signature) 214, (Signature) 33o-y-g <br /> Relinquished by: DATE 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 lArn MCEF 3)25mm 0.4 pm polycarb.filter <br /> 4)PVC filter, diam. - pore size - 5)Charcoal tube 6)Silica get tube 7)Water 8)Soil 9)Bulk Sample <br /> 10)Other 11)Other <br /> COPIES: WHITE-JOBFILE YELLOW-PROJECT FILE PINK-CLIENT <br />