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/1me 1-an EnimU1Tj11C°iNet11'U1k A,La1 �` Page of <br /> _ (`� 1 <br /> 1 Client l- � J <br /> 3440 Vincent Road,f'tcasan! IIPA 9451-3 <br /> Addre-a _ ___ _ _--_—__ Phone(510)930 9090 REQUEST FOR ANALYSES 1 C OF CUSTODY <br /> r 1-AX(510)930 0256 Lab Job Number <br /> Contact _t���v\ ,�1, /�y� a <br /> Lab Destination l- <br /> Alt Contact —1L± <br /> Date Samples Shipped t o —k <br /> Address Roport To Send Invoice To Lab Contact <br /> 2 � Date Results Required <br /> Date Report Required <br /> Client Phone No <br /> Client FAX No <br /> ANALYSIS <br /> Sr-nd Report To 't 'ior 2 (Circle one) e 0 <br /> J �fi <br /> Ghent P O No ���� '� Client Protect l D No <br /> Sample Teim Momber(s) J <br /> L <br /> j <br /> Lab Client Sample Air DTarnet Sample No Type d <br /> Number Identification Volume Type Pres of of Cont Cont a Comments/Hazards <br /> Collected <br /> Tiehnqu[shed by r (� DATE TIME� Receivdd by � � � DATE TIME <br /> (S+gnaturrl CI L.f,J C (i'j f �� _It �i'! ��7 (Signal It,, �/�i`r` 7i l 70 <br /> Relinquished by DATE TIME Received by DATE TIME <br /> (Signature) (Signature) <br /> i <br /> Rettnquuhed 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 pm MCEF 3)25mm 0 4 pm polycarb filter <br /> 4)PVC filter, d[am 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 />