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i He�urtiny Inturnia ' <br /> I Ghent '�7 LI// 'lc+ti'SIL iL Aineiican Env iiol111dCJIr'C�envoik Page of <br /> p 7 j ���� t 3440 Vincent Road,Pleasant Hlil, 94523 <br /> Address Phone(510)930-9090 REQUEST FOR ANALYSIS 1 CHAIN OF CUSTODY , <br /> NL-,6 Ili t1/�' L11 Iy I <br /> Contact Tu�� f7�rJ ".fl FAX(510)930-0256 Lab Job Number 9�7 C� S�' <br /> Aft Contact Lab Destination <br /> RECEIVEOCT 0 8 1996 <br /> Date Samples Shipped <br /> Address Report To Send Invoice To Lab Contact <br /> _ Date Results Required 4 <br /> 2 e Lt 141,?I-A nl �7J�'+S�l 3 _ ��' —2 . Date Report Required <br /> 'S G' r1 ' ) 4 ' #' s L Client Phone No _ ( <br /> C k Client FAX No <br /> ANALYSIS <br /> Send Report To 1 or 2 (Circle one) <br /> Client P O No _ 17—_ ("1? Client)Project D No /C <br /> Sample Team Member(s) NAR r LLA C <br /> Lab Client Sample Air Date/ Sample No Type <br /> Number Identification Volume Time Collected Type` Pres Cont Cont of of Comments/Hazards <br /> alA-C d10- 7 '-904,w 7fly vej A \ x <br /> ozA-C td,W — I //h o <br /> o4-A-c W ' 4 <br /> 1 , <br /> 7 <br /> Relinquished by y /ATE TIME/ Received by J DATE TIME <br /> (Signature) 1� �" / c__--, I���/ I , /� (Signature) �L�G <br /> D E Tl E Received b DATE TIME <br /> Relinquished by � C l Y <br /> C,��r <br /> (Signature <br /> rs� (Signature) j� f ' f/� 'G'/Z ' q12 <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 0 3 pm MCEF 3)25mm 0 4 pm polycarb filter <br /> r <br /> 4)PVC filter, dram pore size 5)Charcoal tube 6)Silica gel tube 7)Water 8)Sod 9)Bulk Sampler ' t, t� <br /> i 10)Other 11)Other <br /> COPIES WHITE JOB FILE YELLOW PROJECT FILE PINK CLIENT <br />