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Reporting InformatiorI., AEN Page <br /> 1 Client -'r, h Vi r i ti 1 f1►1rc'1!c crit L'�rvc�o�u�tental 4vof k <br /> + ' 3440 Vincent Road,Pleasant[Jill,CA 94523 EQUEST FOR ANALYSIS 1 CHAIN OF CUSTODY <br /> Address C ra V wq S q 1 tipd <br /> �{4s1e.lt o Muri a l�A, GT A 9$_� Phone(510)930-9090 <br /> FAX(510)930-0256 Lab Job Number <br /> Contact ,TO£ 9 kt &dcl-cid <br /> All Contact `3 J-3 Lab Destination <br /> K_ f Date Samples Shipped <br /> Address Report To Send Invoice To� Lab Contact ° <br /> 2 S A 3 S B Date Results Required —Sf44Jqw4 TAT <br /> Date Report Required <br /> Client Phone No <br /> Client FAX No <br /> Send Report T1 or 2 (Circle one) YSIS <br /> Client P O No Client Protect I D No N e l S o k �p <br /> +, WhA. <br /> Sample Team Member(s) n R — i { i h V <br /> Type, <br /> - <br /> Lab Client Sample Air Date/ Sample No 4� N <br /> Number Identdicatron Volume Time of of <br /> Collected Type, Pres Cont Cont Comments 1 Hazards <br /> AB5 6 5 -GW L+V3 <br /> gimp b- (T i s LB OLO W IFtr Iiel Lt3 <br /> 314 1110 w4ter - C Lt3U <br /> `f} 5113 S- 115 0 J q 0;_ 5�i� $SI U s y- <br /> s 2 o _n 8 s o 5 0 l{ <br /> 1.0 S111-9 95 0 so Lt, Gr+ss <br /> SW toot SDVL <br /> 8 Sal - I5 —0.2 sf>s TOO Soy <br /> VA� lr �L$ Ilio Sci -- 13v1,s 1V1wI �-I5- 6ILS 17-15 Soil '— t I rVfo <br /> t Mw I - Z5_ s ca 1115 SotL <br /> z� W - — <br /> t3n Mw 2 �rAta — - - — <br /> ILfA Mw 3-- S s > l�ao 5ut — I�trA —Relinquished by by DAT TIME Received by&Ile <br /> DATE TIME <br /> (Signature) S L9 9 $ (Signature) ;J11y�Relinquished by r / r DAT TIME ` <br /> �/ Received by DA E TME <br /> (Signature) �C 7 (Signature) <br /> Relinquished by DATE TIME Received by D TE TIME <br /> (Signature) <br /> (Signature) <br /> Method of Shipment - Lab Comments <br /> 4 <br /> 'Sample type(Specify) i)37mm 0 8 pm MCEF 2)25mm 4 8 pm MCEF 3)25rrim 0 4 pm porycarb filter <br /> 4)PVC filler diam pore size 5)Charcoal tuba 8)Silica got tube 7)Water 8)Sod 9)Bulk Sample <br /> 10)Other 11)Other <br /> COPIES WHI1E JOB FILE YELLOW PROJECT FILE PINK CLIENT <br />