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Chain of Custody Form MIC' ANALYTICAL LABORATORII�INC. <br /> 1046 5900 'Hollis Street, Suite hi, Emeryville, California 94608' SZZZx <br /> Name 1 Client / Address: (510) 653-0824 - (510) 653-1361 - FAX <br /> n. <br /> Pen <br /> tr Lenno Proj ect L <br /> innovative&Creative Asbestos <br /> TEM PLM PCM <br /> Envirgilmental Solutions Lead Only <br /> TfLC[total STLC TCLP <br /> P O Box 99288 ._ <br /> Metals <br /> Fm_eryville CA 9 662 _ (Specify) TTLC(Total) STLC TCLP <br /> Other <br /> Tel. 652-3222 P.O. No. <br /> Fax (510)652-3555 _ Number of Samples <br /> Turn Around Time iV oYM�Igt ( �5_�o+1IS ) <br /> Matrix Type Bulk Dust PaintSoil Wipe Air Water Other j 1J <br /> Time Sampled <br /> Date Start!Stop! Average Total Filter <br /> blicro ID N Client IDN Location ! Description Sampled Total Minutes LPM Liters Pore Size <br /> T-1 9-r� -qq <br /> • ,E <br /> • i <br /> 1 <br /> . . y� Ii WfrQ�iQCIt� p I <br /> Instructions: i! cA S= S—Yt4 C-0 0 7 I PlIq 41 e-A r YC S t�11T S `� 1nR►1ii�11�t-1 cF'l r.I l FY1 <br /> PYi b!! c ri e.a 1� SC.y Y i GEcS <br /> SGf v►..�o q to r� CGo to!7�. <br /> l;Nv. �e.� f�Gt �IVf sfaYl <br /> 30+ F— 1+J��a �Ye 3 T <br /> Sampler's St nature / Name S I a c�e�-O 1 C '157-02-- <br /> ! f(g 9 Drop Box ! Co - If/0 0 <br /> Relinquished By DatelTime Received y Date,lTime <br /> Relinquished By DatelTime Received y Dale/Time <br />