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■*port, #r rr r r. ■Tnvironrr men rk M�.� � <br /> �e1MPage of <br /> Address <br /> American <br /> I 3440 Vincent toad,Pleasant Hill,CA 94523 <br /> Address REQUEST FOR ANALYSIS/CHAIN }OF�CUSTODY <br /> Phone(5 i0)930-9490 <br /> FAX(510)934-0256 Lab Job Number <br /> Contact • �AGr?t2+tlG"!S Lab Destination <br /> Alt Contact ��� AQ�P ,—--— <br /> Date Samples Shipped <br /> Address Report To Send Invoice To Lab Contact <br /> 8 Date Results Required <br /> 2 Date Report Required <br /> 4 n• A Client Phone No - <br /> - Client FAX No _ A► �S2- �rL7 — <br /> ANALYSIS <br /> Send ReportTo 1 or 2 (Circle one) <br /> Client P O No Client Project I D No 4 Q � —70 <br /> Sample Team Member(s) Pr tk02f — <br /> Lab Client Sample Air Date/ Sample No Type <br /> Number Identification VolumeC Timted Type* Pres Cont Cont Comments/Hazards <br /> -5 VDA <br /> i <br /> Relinquished by TE TIME Received by E)AT TIME <br /> (Signature) A, fl �� t. (Signature} v <br /> Relinquished by !� A E TIME Received b AT7� <br /> TIME <br /> (Signature) '/ (Signature) ME <br /> `(e <br /> Relinquished by 'CMlf TIME Received by DATE TIME <br /> (Signature) (Signature) <br /> Method of Shipment tab Comments <br /> I <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 filler, 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 FIC E 1 ELLOW PROJECT FILE PINK Cl iFNT <br />