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Reporting informatiSri,, A ]� <br /> 1 Client _ _! C�1�(L t t �,I A111L'1 um r',lI1�Il U!l111enfallolivoi k 1`�I iN Page of , <br /> Address ;J f i �1 3440 VI@Cent Ruad, NUISdnt 11111, 0 523 REQUEST FOR ANALYSIS 1 GRAIN OF CUSTODY <br /> Contact FAX(510)930 0256 Lab Job Number <br /> Contact Lab Destination <br /> Date Samples Shipped <br /> Address Report To Send Invoice To Lab Contact <br /> i 2 3 Date Results Required <br /> Date Report Required <br /> !� r (' <br /> Client Phone No <br /> Client FAX No <br /> Send Report To 1 oro(Circle one) <br /> ANALYSIS <br /> Client P O No Cltent Project I D No �© l <br /> 7 L`rV, <br /> Sample Team Member(s) !— LG'wNo <br /> �c <br /> Lab Client Sample Air Cate/Time Sample Pres of Toe <br /> Number Identification Volume Collected Type* Cont Cont Comments/Hazards <br /> +~ <br /> ,0.2-,4,6c -Z 3 <br /> 0 <br /> BC' <br /> 6 Gf1-- i <br /> 07 UI Z4,3 <br /> Relinquished by , DATE TIME Received by DATE TIME <br /> {Signature) L�y�r / Z _z7 7 2'` '�7 d <br /> Relingwshed by ATE TIME Received by DAT TIME <br /> (Signature) -Z l.( `�7 (Signature) 7 ji <br /> Relinquished by DATE TIME30 <br /> Receive ATV' TIME <br /> (Signature) <br /> (Signature) <br /> Method of Shipment Lab Comments <br /> t ' <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 filler, diam pore size 5)Charcoal tube 6)Silica gel tube 7)Water 8)Soil 9)Bulk Sample <br /> 10)Other 1 t)Other <br />