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w ww w■ w w w w w� r11Tww - w w� w <br /> Reporting tnformratlo c <br /> I Client X10�i 2�i+r 1. (� f <br /> Amens n Envtr nmental orwl�k �1 Page <br /> Address -7 S Art c, I-)`'y f 3440 Vincent Road,Pleasant Hill,CA 94523 <br /> REQUEST FOR ANALYSIS 1 CHAIN OF CUSTODY <br /> Phone(510)930-9090 <br /> Contract FAX(510)930-0256 Lab Job Number r t <br /> All Contact C ('{< <} bSt ,� c i +~, Lab Destination <br /> Date Samples Shipped <br /> Address Report To Send Invoice To Lab Contact <br /> Date Results Required <br /> 2 ''LAt� L r ( 3 j'r ;�Rl�q I�� �,i t Date Report Required <br /> ,t , t �_' rG t-, Client Phone No <br /> ,6V_r i r L c E1 ? 1 . J 3 �}� 1 '' sG L ! (`r � ) Client FAX No <br /> ri' � -jl .3l1 i n', xl i )': j l rf 1 �I� � ) f' �rl I ()' vg %!� 3r `1 1 <br /> � <br /> Send Report To 1 or 2 (Circle one) ANALYSIS <br /> Client P 0 No Client Project 10 No �a Oa 021 3 <br /> Sample Team Member(s) <br /> No <br /> Lab Client Sample Air Ti el me Sample Pres of Tope k Q <br /> Number Identification Volume Collected Type' Cont Cont 4Q�� Comments I Hazards <br /> W ' 14 ):-G7 1 1 \A )c k <br /> `^i 1 a 1\ r i s --3 7 ��m ,, 4— k X 1C \'r f'' o k Y <br /> w 11 !`I Lf3 `7 - f Boor+c - <br /> 1U vi ) rl r 4 K x <br /> W- ), X <br /> IG7� 10 '�1\1 <br /> X /K <br /> J L'De f -1V Gi X <br /> 11 A <br /> , In <br /> tri tr � <br /> 'M Eao 7 -N <br /> Relinquished b ATE TIME Received by�� ' DA E l TIME <br /> (Signature) ( (Signature) G �� ^� f l �� <br /> Relinquished by �t/E TIME Received by i 1 DATE TIME <br /> (Signature) �!a �QG (Signature) �` S ( i i I l)( <br /> Relinquished by DATE TIME Received by DATE TIME <br /> (Signature) (Signature) <br /> Method of Shipment Lab Comments <br /> 'Sample type(Specify) 1)37mm 0 8 pm MCEF 2)25mm 08 pm MCEF 3)25mm�4 pm polycarb filter <br /> 4)PVC filter diann pore size 5)Charcoal tube 6)Silica gel tube jj later j)Soil 9)Bulk Sample <br /> 10)01h or 11)Other <br /> COPIES WHITE JOl!rILL YELLOW PROJECT FILE PINK CLIENT <br />