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Reporting Information: / <br /> American Environmental Network AEN LA�S-C Page of <br /> 1. Client: vri <br /> Address: [►���c �� cc_,'tcr�� q .5 344()Vincent Road,Pleasant 9l,CA 94523 REQUEST FOR ANALYSIS/CHAIN OF CUSTODY <br /> S-t-oCr-�Y+i1 G Phone(510)930-9090 n )n 1 <br /> Contact: FAX(510)930-0256 Lab Job Number: <br /> Alt.Contact: Lab Destination: <br /> Date Samples Shipped: <br /> Address Report To: Send Invoice To: Lab Contact: <br /> Date Results Required: <br /> 2' S!� 1- 0 L'- !` 3' Date Report Required: <br /> Client Phone No.: 2' <br /> Client FAX No.: .0 n <br /> ANALYSIS <br /> Send Report To: 1 or 2 (Circle one) <br /> �1 �) ` <br /> Client P.O.No.: �} Client Project I.D.No/. 00/—O no <br /> Sample Team Member(s) sL-� (,►. /lt t'i—sQ�j��/ �r�.�• �I Q �� v� �r� <br /> Date/ No. Typet t� VJ <br /> Lab Client Sample Air Time Sample Pres. of of <br /> Number Identification Volume Collected Type. Cont. Cont. (� r� Ci 1QA, Comments/Hazards <br /> 6 <br /> 1 Ili. I <br /> - <br /> Z <br /> iiie <br /> Relinquished by PATE TIME Received by: p DATE TIME <br /> (Signature) 2 5 3 (Signature) p( 7-1-cLh ISS5 <br /> Relinquished by: DTE TIME Received by: DATE TIME <br /> (Signature) (Signature) <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 0.8 pm MCEF 3)25mm 0.4 pm polycarb.filter <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 /> rnmr, 'AlHITF .IoR n r n I,. —-, r plNk r+ rnT <br />