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Repariing inform n <br /> 1 client American EnvironnienI&Yetwork E Page of ! <br /> Address U 3440 Vincent Road,Pleasant Hit , 94523 - REQUEST FOR ANALYSIS 1 CHH OF CUSTODY <br /> �q K p 4 4 [ Phone{510)930-9090 <br /> Contact _ - Ijy/q- i't. D.501j FAX(510)930-0256 Lab.fob Number �'L C)al ' <br /> Alt Contact Lab Destination <br /> RECEIVED ,SUN 1 8 19% Date Samples Shipped <br /> Address Report To Send Invoice To Lab Contact <br /> 2 3 Date Results Required 5-0 N D <br /> A - Date Report Required <br /> Client Phone No IU _ b 0 <br /> Client FAX No G g <br /> ANALYSIS <br /> Send ReportTo1 or 2 (Circle one) <br /> "',ent P O No l"" 10 I rClient Protect I D No _ D ` 10 { <br /> sample Team Member(s) <br /> Lab Client Sample Air Date/ Sample No Pres of Tope ` <br /> Number Identification Volume Time Collected Type Cont Cont Comments/Hazards <br /> of low G l 3 vo<t TWx X <br /> r <br /> -cl MW--Z 10Z I It` <br /> -c MW -3 I <br /> -c MIJ <br /> l . <br /> 05A L M w <br /> Relinquished by J DTE TIME Received by 1•� DTE TIME <br /> (Signature) �� - (Signature) <br /> Relinquished by ATE TIME Received by DTE f TIME <br /> (Signature) (Signature) . - T 6 3 9 3 ' oO <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)Sod 9)Bulk Sample <br /> 10)Other 11)Other <br /> COPIFS WHITE JOB FII E YELI OW PROJFCT FILF PINK CI rrNT <br />