Laserfiche WebLink
Reporting Information <br /> 1 Client � �1r,� <br /> American Environmental Network AEN Page� of <br /> 0 G` <br /> Addross 9 3440 Vlnf-Ult Road,PiLaWnt I III],CA 94523 REQUEST FOR ANALYSIS/CHAIN OF CUSTODY <br /> Phone(510)930-9090 <br /> Contact 1 AX(510)930 0256 Lab Job Number <br /> Alt Contact Lab Destination <br /> Date Samples Shipped <br /> Address Report To Send Invoice To Lab Contact <br /> Date Results Required <br /> 2 '�- 3 Date Report Required <br /> Client Phone No <br /> Client FAX No <br /> i r 31. c <br /> Send ReportTo 1 or�( ircle one} ANALYSIS <br /> Client P 0 No Client Project I D No <br /> Sample Team Member(s) i� <br /> Lab Client Sample Air Date/ Sample No pies of Tope <br /> Number Identification Volume Time Collected Type* Cont Cont Comments/Hazards <br /> 62-// <br /> 6 1wc <br /> C 13 'i <br /> ' to <br /> W12 16 v-. <br /> c - <br /> C41 lot s5 <br /> C - .?--r 9 <br /> It <br /> (2-/S <br /> Relinquished by DATE TIME Received by DATE.,- TIME <br /> (Signature) Z / / ` (Signature) , q 1- <br /> Relinquished by DATE TIME Received b TE TIME <br /> (Signature) . f� (Signature) / Q <br /> Relinquished DAfE TIME Received by DATE TIME <br /> (Signature) (Signature) <br /> Method of Shipment tab 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, diam pore size 5)Charc a 6)Silica gel tube 7)Water 8)Soil 9)Bulk Sample <br /> = either _ <br />