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Repo rting n on <br /> i client I C- m GVA.,w American Environnien Network AfN m <br /> r Page o1 <br /> Address 1 o V6,07 LAS, mg, 3440 Vincent Road,Pleasant Hill,CA 94523 REQUEST FOR ANALYSIS 1 CHAIN OF CUSTODY <br /> � �9 C, N Phone 010)93(1-9090 �O Z <br /> Contact �aeafla FAC:���S I-AX(fi(l)l?1(f-i}251i Lab Job Number <br /> Lab Destination <br /> All Contact 50 944 *F"st _ <br /> Date Samples Shipped <br /> Address Report To Send Invoice To Lab Contact /NO <br /> Date Results Required SlAv1�R,N xa r 6 <br /> 2 A3 d5 d ofjue- __ __ Date Report Required <br /> Client Phone No 2- "1 <br /> Client FAX No r <br /> ANALYSIS <br /> Send Report To 1 or 2 (Circle one) o <br /> Client P 0 No Client Protect I D No T BZQ^-cxi—crt> <br /> �a <br /> Sample Team Member(s) • 1rV <br /> Lab Client Sample Air Date/ Sample No C <br /> peNumber Identification Volume Collected ime Type' Pres Cont ont h4 of of Comments/Hazards <br /> 01A MW'"-20 w6h Y Ili <br /> s o <br /> 07A V601-OS W, <br /> ✓ a sa t—t0 b C9oo i x _ — <br /> ✓ 04 J-rat)y_ t 10 0%5 r F S <br /> ✓ t30%I Zo <br /> v V160I --zs- rk ZTh <br /> 03 Jia -3u oat 1 <br /> 08,4 V 00 I—3S 19 oq-30 1 X <br /> o 2A VBD+ -40 OqK I + <br /> o _ 10to ! <br /> ✓ �A Seo I - r o X050 ! <br /> o C4"—t vie <br /> ✓ a 5150 _ 5 a ilio 1 k rw <br /> 15A $'Bo 1- 20 I1z0A ---J-I-- I F K 1% A] <br /> 1! <br /> ,4 :nBo I —23" <br /> Relinquished by DATE TIME Received byAJ DTE TIME <br /> (Signature) a. (O y 1-0 — (Signature) �a 'j ,SO� <br /> Relinquished by DTE TIME Received by DATE TIME <br /> (Signature) d 00 (Signature) <br /> Relinquished by DATE TIME Received by DATE L TIMg /E <br /> (Signature) (Signature) 7r Q <br /> Method of Shipme t Lab Comments <br /> 'Sample type(Specify) 1)37mm 0 8 pm MCEF 2)25mm 0 8 pm MCEF 3)25mm 0 4 Nm polycarb I111er <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 IOR ill E YR LOW PROJFCT EI1.F PINK CLIENT <br />