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fiepoiluig Information: ALEN � <br /> American �;114'll'U/UI([ wal Nell wrk � Page _ of _I_ <br /> 1. Client: � _ <br /> �- -c L�7eY�( 1.C— 3440 Vincent Road,Pleasant Bill,CA 94523 5 1 e-e-"C- REQUEST FOR ANALYSIS/CHAIN OF CUSTODY <br /> Address c t Lcx�� Phone(510)930-9090 <br /> Contact: � T�i�- I-AX(510)930-(1256 ��SiS' F Lab Job Number: <br /> Lab Destination: <br /> All.Contact: <br /> Date Samples Shipped: <br /> Address Report To: Send Invoice To: Lab Contact: <br /> Date Results Required: F'' - <br /> 2' <br /> ;5,!,:J1- E 11L( Sc�l1- { r 3' Date Report Required: <br /> F• Lkl <' 1 Vic Client Phone No.: 5 lo.) -7 9 .1-3 <br /> (,-,?0 e d, b 1r ) Client FAX No.: Si 0 n 3 - /9 C2F <br /> t�r7,_c""'d 9 ,moi l <br /> _ ANALYSIS <br /> Send Report To: 1 or 2 (Circle one) \ <br /> Client P.O.No.: L-�'' 'i 2 Client Project I.D.No.: <br /> Sample Team Member(s) X"f'7f Gin�J/�!��?-�� 1�F�� ,�j� ( �^ <br /> Date/ No. Type IJ A. 7 <br /> Lab Client Sample Air Time Sample Pres. of of <br /> Number Identification Volume Collected Type Cont. Cont. v Comments/Hazards <br /> 016 z w , /0y-, l Rn i I,-" <br /> 03A —he, r v ✓ �' ✓ -- <br /> Relinquished by: DATE TIJE Received by: DATE TIME <br /> (Signature) $ r (Signature) p P /s <br /> Relinquished by: DA t 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 Nrp MCEF 2)25mm 0.8 pm MCEF 3)25mm 0.4 um polycarb.filter <br /> 4)PVC filter, diam. pore size \�)Charcoal tube 6)Silica gel lube 7)Water 8)Soil 9)Bulk Sample <br /> 10)Other \ 11)Other <br /> COPIES: WHITE-JOB FILI) YELLOW.PROJECT FILE PINK-CLIENT <br />