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10/21/2005 10:53 FAX 209 9480621 1 009/010 <br /> Dec 16 03 11 : 46a 19sbecln 916-43975 p.z <br /> BULK SAMPLE - ANALYSIS REQUEST <br /> P.O.NUMBER <br /> 3 5 -5- <br /> ASBESTECH <br /> 6825 FAm OAKS DLVD.,STE 10.3 <br /> CARMICHAEL L.CA 9560$ TEL (916)481.8902 FAX(016)461.3975 <br /> NAME OF COMPANY SAMPLFCOLLECTED BY DATE COLLECTED <br /> kLri PEL9� <br /> 0z ; ' DoN o ,4KLco 12--3 -03 <br /> MAIUN13 ADDRESS SPECIAL INSTRmmoNSJTURNAROUND TIME <br /> 6-roc, ;"a e,A Ac-(-- <br /> TELEPHONE NO. <br /> LAA ASBESTOS OTEM A56ESTOS CIM LEAg1 PAU> T SAA LEAD WIPE ©AA LEAD 501V77LC ❑LEAD STLC ❑LEAD TCLP <br /> SAMPLE Y SAMPLE LOCATION' SAMPLE DESCRIPTION <br /> NUMBER <br /> TAX <br /> oC-�i r N-r 1-lo� 50vTt4; WAL-L QI✓ Spic £� 12 1 aJL <br /> DE-2 E-"rE5P-10jZ W Com` ;bU*L-L " r <br /> oe-3 e7Ar-.�'r 'W*u, r� <br /> cpe-4 1 pi-roa l ores GEST .w 44-L CoNG�E"fE T�ou1EL rvW <br /> I <br /> i <br /> ' I <br /> 1 <br /> CHAIN OF C S DY <br /> RELINQVISHED,BY: fIECC(VED BY: RECEIVED BY: <br /> DATE/TIME: (]Al E%TIfdEE: , -L - DATE/TIME: <br /> I <br /> I <br /> 12/16/2003 TUE 12:38 [TIL/RX NO 76261 U002 <br /> I <br />