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ftoporting Inlorrnatlon AEN <br /> ]�� /' <br /> 1 CAent .� ,.,c , American Environmental Network L'1L' L � Page._52__ of <br /> Address Phone(510)930-9090 <br /> 3440 Vincent Road,Pleasant CA 44523 REQUEST FOR ANALYSIS 1 CHAIN OF CUSTODY <br /> b9Q <br /> Contact PAX(5 f 0)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 ro 3 _ — Date Report Required <br /> 1 . 0 <br /> Client Phone No <br /> Client F�X No <br /> s <br /> ANALYSIS <br /> Send Report To 1 or(2�00ircle one) <br /> 4 <br /> Client P O No Client Project I D No <br /> Sample Team Member(s) d G.s <br /> Lab Client Sample Air Cate) Sample No TyOf pe <br /> Number Identification Volume TimeCollected Type; Pres Cont Cont Comments 1 Hazards <br /> rc. <br /> Relinquished y ATE TIME Received by DTE �, TIME <br /> (Signature) (Signature) LY <br /> Relinquished by DAT IME Received try A E TIME <br /> (Signature) (Signature) <br /> E2 <br /> Relinquished y ATE TIME Received by DATE TIME <br /> (Signature) (Signature) <br /> Method of ShipmenV Lab Comments <br /> `Sample type(Specify) 1)37mm 0 8 pm MCEF 2)25 08 pm MCEF 3)25mm 0 4 pm polycarb filter <br /> 4)PVC filter, diam pore size 5)Charcoa B)Slllca gel tube 7)Water 8)Sall 0)Bulk Sample <br /> M M M 1C r or M = M M*= <br />