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flrlpor1ing I i it orAkn <br /> 1 Client f�l!!ellCQl2 EIlV11011111e12�NetWOI k �' pape ., of <br /> �Cc�LaL� <br /> Address 3440 Vincent Road, Pleasant 11111,CA 94523 <br /> _�)Q��u�tl ' � +�[) � _ <br /> Phone(510)930 9090 REQUEST FOR ANALYSIS/CHAIN OF CUSTODY . <br /> Contact �ciL=__..L it _ FAX(510)930 0256 Lab Job Number a-L) <br /> Alt Contact Lab Destination <br /> tt Date Samples Shipped ......� <br /> Address Report To •^r l - Send Invoice To I Lab Contact <br /> 2 J 3 Date Results Required <br /> Date Report Required <br /> Client Phone No <br /> i <br /> — --- Client FAX No <br /> Send Report To /�l or 2 (Circle ane) i, <br /> ANALYSIS <br /> Client P 0 No Client Project I D No <2 )7001_(25' 651005- <br /> Semple Tearn Member(s) �t&t� <br /> Lab Client Sample Air Date/ Sample No - Type r <br /> Number Identification Volume Time Type of of <br /> Collected Cont Cont Comments/Hazards <br /> - '-'—�— <br /> —F I 1f I11,c OO <br /> RPlinquishpd byDATE r TIME Received by DATE TIME <br /> (Signature) LJ j (Signature) <br /> 4t <br /> • r <br /> Relinquished by DATE TIME Received by DATE TIME <br /> (Signature) (Signature) <br /> Relinquished by DATE TIME Received by DATE TIME <br /> (Signature) (Signature) <br /> Method of Shipment Lab Comments <br /> I <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 dram pore size 5)Charcoal tube 6)Silica get tube 7)Water 8)Soil 9)Bulk Sample <br /> 10)Other 11)Other <br /> COPIES WHITE JOB FILE YELLOW PPOJECT FILE PINK CLIENT <br />