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Reporting Information American Envirgnmentat Network AEN It Li Page of <br /> m <br /> J. Client jL10U2l�►4++nzL <br /> �+ '757f�nu.. �. 5.�+ 1� 3441?Vincent Road,Pleasant Htll,CA 94523 pgpQEgT FOR ANALYSISJ CHAIN OF CUSTODY <br /> o Address Phone(510)930 9090 E <br /> ig rrq Fz CA C;'+s FAX(510)930-0256 Lab Job Number <br /> Conlact 'D A �If`tCe` Lab Destination <br /> Alt Contacl t 0 Date Samples Shipped <br /> Send Invoice To Lab Contact <br /> Address Report To Date Results Required <br /> _ <br /> 2 � 2 - t �,Z ( 3 f r ' 'r`' ' +l=+- ` 1 Date Report Required <br /> + i, ;'r + t _ Client Phone No <br /> Cliant FAX No <br /> •Z- <br /> yj r n kl y i ' I ANALYSIS <br /> Send Report To t or 2 (Circle one) <br /> Chani P O No Client Project 1 D No ' <br /> I F Q ` <br /> Sample Team Member(s) <br /> Dalel No Tge L.A.Lab Client Sample Air Time Sample Pres of ,I~f �� Comments!Hazards <br /> Number Identification Volume Collected Typo Cant Cont <br /> SIT <br /> —77 <br /> 77 y <br /> o• t ►wl <br /> W <br /> Ilk, <br /> K <br /> i- <br /> NJ <br /> U! ~j I EN <br /> . DA[!!�� . <br /> TIME <br /> Receed by l'if <br /> catqshed (Se1 TIMEG1 (Signature) f-5 Et ' � GATE <br /> TIME Received r Relinquished 1 IE /fQG (Signature)by •, ( f 4 TIME <br /> rl <br /> (Signature) !a DATE <br /> RehngLdshed by GATE TIME Signal by <br /> (5ipnaare} ( 1 <br /> of Shipment <br /> Method Lab Comments <br /> 'sample type(Specify) 1}37mm o S pm MCEF 2)25rnm 0 a pm MCEF 3}25mrn 4 um poiycarb fuer <br /> 4)PVC filler, dram pore size 5}Charcoal tube 81 Slbca gel lube Watsr�)Soil Sy Bulk Sample <br /> n <br /> 10}Other 41)Other <br /> WPiEIi. MI}iTE JDB FQE Yft.lOYit PROJECT FILE P7N1( GiIFNr <br /> L 0 0 <br />