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—,zi—ung-inrormation; <br /> 1. Clieh, American Environmental Network <br /> Address: 3440 Vincent Road,Pleasant Hill,CA 94523 AEN Page of <br /> Contact: Phone(5 10)930-9090 <br /> V., I- FAX(510)930-0256 REQUEST FOR ANALYSIS CHAIN OF CUSTODY <br /> It. Contact. ----------- Lab Job Number: I,A 5U <br /> Lab Destination. <br /> Address Report TO: <br /> Date Sam <br /> 2. Send Invoice TO: ples Shipped. <br /> 53. Lab Contact: <br /> Date Results Required: <br /> Date Report Required: <br /> Client Phone No.: <br /> Client FAX No.: <br /> Send Report To: I or 2 (Circle one) <br /> Client P.O.No.: ANALYSIS <br /> Client Project I.D.No.: <br /> Sample Team Member(s) <br /> Lab <br /> Client Sample Air Date/ <br /> Number IdentificationVolume Time Sample No. Type <br /> I ..1k <br /> Collected Type� Pres. of of <br /> ) - I I\ .. <br /> . <br /> COMMCommentsHazards <br /> u 1 i't Cont. Cont <br /> f <br /> Relinquished by. <br /> (Signature) _,_( /� / / ............ <br /> 71 E <br /> TIME <br /> Received by: <br /> Relinquished by, ./"60 0— _. )) i <br /> A­� <br /> c. <br /> (Signature) A TIME <br /> DATE <br /> TIME 3" <br /> Relinquished by Received by:(Signature) DATE <br /> I I I'l - TIK4E <br /> (Signature) TIME t/V <br /> Method of Shipment Received by: <br /> (Signature) DATE TIME <br /> Lab Comments <br /> *Sample type(Specify): 1)37mm 0.8 pm MCEF 2)251mm 0.8 11m M <br /> 4)PVC filter, CEF 3)25mm 0.4 Prn Polycarb.filter <br /> ("am, — 130te size_ 5)Charcoal tube 6)Silica gel tube 7)Water 8)Soil <br /> 10)Other r 9)Bulk Sample <br /> COPIES: WHITE-JOBFILE YELLOW-J. T FILE PINK-CLIENT <br />