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orting,nformat American Environmental etwork AEN 0 ' Page �f y <br /> :Bent r r � c ri o � <br /> Arty a t SAe-6 Vincent Road,Pleasant H�11,CA 94523 REQUEST FOR ANALYSIS/CHAIN OF CUSTODY <br /> address Phone(510)930-9090 {� <br /> n z. C A 3 FAX(510)930-0256 Lab Job Number 1 10`J 0 1 0 _ <br /> Contact Cr Y C o <br /> Lab Destination _ <br /> All Contact sai,,iltrihC St <br /> Date Samples Shipped <br /> ddress Report To Send Invoice To Lab Contact t <br /> Date Results Required �t�Ctard T.61 _ <br /> 2 3 Date Report Required <br /> Client Phone No <br /> 1b) 37b- 3g�Q <br /> Client FAX No (SZra --270- 399/ <br /> ANALYSIS a <br /> Send Report To1O or 2 (Circle one) <br /> Client P O No Client Project I D No 0170202J3 . <br /> Sample Team Member(s) Mork L-1,01ka <br /> x <br /> Lab Client Sample Air Dame Sample No Type <br /> Number Identification Volume C Ilected Type Pres Cont Cant Q of of Comments <br /> /Hazards <br /> I `tb 7 MCL- 2 400111 I r 6VN No IPT5 %%l <br /> (XA4 I 1L <br /> fA Cur 10 I LL 40-1 YQ I � <br /> b„� - MID 40NI 1 XJ <br /> Hrjoz 1 5c10F"1 <br /> cAf-kMID <br /> Awn EFFHK L 1, 'tQrr+1 <br /> t* �, F F <br /> OVP v, EFFpch5o�r�1 <br /> F r L <br /> Relinquished b r9ATE TIME Received by DATE TIME <br /> (Signature) y J /7 q /9 ,2 (Signature) ,S-"?-�{ (� ) i"I-,1, <br /> Relinquished by DATE TIME Received by DATE TIME <br /> (Signature) (Signature) <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 um MCEF 2)25mm 0 8 Nm MCEF 3)25mm 0 4 um polycarb filter <br /> 4)PVC filter, diam pore size 5)Charcoal tube 6)Silica gel tube 7)Water 8)Soil 9)Bulk Sample <br /> 10)Other 11)Other <br /> COPIES WHITE JOB FILE YELLOW PROJECT FILE PINK CLIENT <br />