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Reporting Information: <br /> 1. client: ` tea. American Environmef vetwork AEN <br /> 3440 Vincent Road,Pleasant HtI sA 94523 Page of <br /> Address: <br /> Phone(510)930-9090 REQUEST FD ANALYSIS/CHA!N OF CUSTODY <br /> Contact: FAX(510)930-0256 Lab Job Number: (�� <br /> , <br /> Alt.Contact: r Lab Destination: 3 <br /> 37 5 fJ Date Samples Shipped: <br /> Address Report To: Send Invoice To: Lab Contact: <br /> 2• pd 3. / Date Results Required: <br /> 0.T,44 <br /> f.��C,ril -.....- _. . <br /> s _ .-..-. . . I-lgL _ Date Report Required: <br /> Client Phone No.: <br /> Client FAX No.: <br /> Send Report To: 1 or 2 (Circle one) _c ANALYSIS <br /> Client P.O.No.: Client Project I.D.No.: V <br /> Sample Team Member(s) V <br /> Lab Client Sample Air pate/ Sample No. Type 6 <br /> Number Identification Volume Time Pres, of of <br /> Collected ype Cont. Cont. <br /> Comments/Hazards <br /> Z <br /> Inq 68 <br /> r <br /> =oc <br /> Relinquished by: p TE <br /> r TI E Q Received by: DTE <br /> (signature) TIME <br /> (Signature) /E E <br /> Relinquished by: TIME Received by: <br /> (Signature) DATE TIME <br /> oe <br /> 30 l Y�D (Signature) _ C� <br /> Relinquished by: DTE AM ri J�0 <br /> (Signature) G J C. Received y: _ DATE TIME <br /> Method of Ship n -�� v (Signature) <br /> Lab Comments <br /> 'Sample type(Specify): 1)37mm 0.8 um MCEF 2)25mm 0.8 pm MCEF 3)25mm 0.4 Nm polycarb.filter <br /> 4)PVC filter, diam, pore size 5)Charcoal tube 6)Silica get tube 7)Water B)Soil 9)Bulk Sample <br /> 10)Other 11)Other <br /> COPIES: WHITE-JOB FILE YELLOW-PROJECT FILE PINK-CLIENT <br />