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Reporting Information: <br /> 1. Client ATnerican Environmental Neavork AEN Page_ of <br /> Address: - 3440 Vincent.Road, Pleasant Hill,Ck 94223 <br /> Phone(S 10)9311.9090 REQUEST FOR ANALY819!CHAW OF CUSTODY <br /> c� <br /> FAX(510)930 0256 Lab Job Numbs <br /> Confa.t: r. 6 9y o <br /> Alt.ConhcCR �• �,A Lao Destina•ion: N Date Samples Shipped: <br /> Address Repan To: Send Invoice To: Lab ContacT _ <br /> 2 a Date Results Recuired: <br /> f� C <br /> AieearrJ&J&m Date Report Required. <br /> Clierr Phone No.: a-1 <br /> Cliem FAX No.: rn <br /> ANALYSIS <br /> Send Report To 'D�)or 2 (�Cllmla ane) <br /> Cl kin,P.O No.: Oj'7 0�, Client Proved I.D.No.: 100t 03--A-1 V z <br /> Sample Team Member(a) 4&15ex / ( r <br /> Lab Client Sample Nr Sample pres. lot Type <br /> T <br /> Number Iden6ticafior Volume Time Collect Tom• Cont. Cont. 4 Comments I Hazards z <br /> 9 <br /> P- rl <br /> 11 <br /> Y S I Ir• <br /> r t1. A <br /> 001.4 <br /> Lj 11 ( x <br /> z <br /> u <br /> W <br /> 0 <br /> C <br /> Relingrdsllediny: DATE TIME Recelvei by. ((�� • CATE TIME <br /> ;8ignWrel r (Signature} <br /> Relinquish DATE TIME Received by: DATE TINE <br /> ?Sigpii Wrel (Signature; <br /> :Relinquished by. DATE TIME Recemed by DATE 7IME <br /> (Signalurel (Signalurel <br /> Method of Stipm-a Lab Comments -v <br /> 0 <br /> N <br /> 'Sample type ispeeify) 1)37mm 0.6 pm MCEF 2)25mre 0.e yin IJCEF 3)25mm 0.4 pm pclyearo.Niter <br /> 4)?YC filter, diam. _ pore size_ 5)Charcoal rube 6)Slica get tube 71 Wab 8 3 9)Bulk Sample o <br /> 10)Other 11)Other <br /> CO-ES: V6WIE-.IDBFILE YEL_oW-PROJECT UE RNn-CLIENT <br />