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-Glenn ,F1 M AmM�unTnnvirr rW en 1M7 �,f "-3. " M �!r <br /> Address Z9 1pol.'e6454 �1 3440 Vincent Road,Pleasant Hill,CA 94523 REOUEST FOR ANALYSIS/CHAIN OF CUSTODY <br /> �p Coe MA Phone(510)930-9094 q 5 O 2-0 <br /> Contact AlOYA <br /> L FAX(510)930-0256 Lab Job Number <br /> AN Contact ToNN aj`(L_ Lab Destlnatlon <br /> Date Samples Shipped <br /> Address Report To Send Invoice To Lab Contact <br /> 3 Date Results Required - <br /> Date Report Required <br /> Client Phone NoV. 4 <br /> Client FAX No <br /> ANALYSIS <br /> Send Report To 1 or 2 (Circle ane) LL�� O�n 4Z) <br /> CIIW P O No Client Project I D No T�17 w� w-00 <br /> Sample Team Member(s) t'�'+�t/FS� <br /> Lab Client Sample qtr Date/ Sample No Pres of of a <br /> Number Identification Volume Collected Type*ime Cont Cont Comments/Hazards <br /> 4 4 A.-r- O?we c1z AR I C'00c 4* c74Z&s <br /> v Lig (.,I M w-1 311h3- X lok-r <br /> out-a <br /> asn- A4 w/, r I X <br /> IM A3a <br /> Relinquished }� A Received by <br /> {Signature) J.r�%% Z 1 '�j (Signature) <br /> Relinquished by ATE TIME ReCeiYed b DATE TIME <br /> (Signature) r ^� �4d (Signature) �� -q1%00 <br /> Relinquished by j ATE TIME Received by DATE TIME <br /> (Signature) s (Signature) <br /> Method of Shop nt Lab Comments <br /> -Sample type(Specify) 1)37mm 0 8 pm MCEF 2)25mm 0 8 pm MCEF 3)25mm 0 4 pm polycarb filter <br /> 4)PVC filter, dram pore size 5)Charcoal tuna B)Silica gel tube 7)Water 8)Soil 9)Bulk Sample <br /> 10)Other 11)Other ' <br /> r <br /> COPIES WHITE JOB FILE YELLOW PROJECT FILE PINK CLIENT <br />