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'1_7ortiny natio ::;: r`l 7-1 l- <br /> 1. Client: U, U. ( i'�' I <br /> American Environmental Network ATIV 1(_' - a) r 11, - Page - of t <br /> fe w t_.�c` '� � <br /> 3440 Vint Road,Pleasant Hill,CA 94523 <br /> Address: (�Z 5 G`11 Vincent <br /> (510)930-9090 REQUEST FOR ANALYSIS/CHAIN OF CUSTODY <br /> Contact: FAX(510)930-0256 Lab Job Number: <br /> Alt.Contact: �''� P ��' �' Lab Destination: <br /> }si Date Samples Shipped: <br /> Address Report To: '-_• F; Send Invoice-TIO: Lab Contact: <br /> I { Date Results Required. <br /> 2. C-.v-k- <br /> t � 3 Date Report Required: <br /> Wz-5 'e Client Phone No.: , u <br /> cn�2c�GC vruocJc, C Client FAX No.: 'Jl0--523 - <br /> ANALYSIS <br /> Send Report To: 1 or 2 (Circle one) _1 <br /> 014 <br /> Client P.O.No.: Client roject I.D.No.: r,L J ,v <br /> GtV. <br /> Sample Team Member(s) <br /> Lab Client Sample Air ' me Date/ Sample of of <br /> No. Type �Z <br /> Number . Identification Volume CollPres.Collected Type* Cont. Cont. l_ Comments/Hazards <br /> mt o 3 11-7,Z(Foo Tee oc" e- `T'P;T- a G.I <br /> 11•?115 `1'49 7 00 Z ?v"VV• <br /> lYlw 1 1 C7ZC -� ZZ-TI ely "l ^ 7 y-c5 3 �U LIR <br /> ALL ShV-A\?L US <br /> u <br /> `TO CL Cf` P.wATC K <br /> v oN `KGwi <br /> Kt S3L D PH s <br /> FAx WL 209- V — <br /> U13 <br /> Relinquished by _ DATE TIME Received b I DATE TIM <br /> (Signature) �1� �,�ro� /� 2 `13 J'3cJW� (Signature) r41L 1 7 - 7 <br /> Relinquished by: DATE TIME Received by: [�A}}TE TIVE, <br /> • 1, <br /> (Signature) INA ( 7 Z C' : 5�7 (Signature) / <br /> Relinquished by: . fl AT ' ,'IME Received by: DATE _ TIME <br /> (Signature) !! L �L �c��� S / (Signature) :(.(/�.P (�: t-- .�/� I�L f �' Z"� t 261D. <br /> Method of Shipment 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, diam. pore size 5)Charcoal tube 6)Silica get tube 7)Water 8)Soil 9)Bulk Sample <br /> 10)Other 11)Other <br />