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i <br /> Reporting Info <br /> 1 Client IC o ,� rc �, Amej 1CL112 Ei1Vli'o11YYlenAetwork ]E r <br /> ALiN Page of <br /> Address U J l t 3440 Vincent Road,Pleasant Hill,CA 94523 <br /> Phone(510)930-9090 REQUEST FOR ANALYSIS 1 CHAIN OF CUSTODY <br /> Contact FAX(510)930-0256 Lab Job Number <br /> Alt ContactYt/l et, Lab Destination , <br /> Date Samples Shipped <br /> Address Report To Send Invoice To <br /> 2 <br /> Lab Contact <br /> LAI / <br /> J 1->��v .1* C�P—Q._ ,. €r��� 3 s Date Results Required f <br /> 7ZF L—tf . 0 Date Report Required i <br /> Client Phone No <br /> Client FAX No <br /> Send Report To 1 0 2 Circle one) �2^ / ANALYSIS <br /> Client P O No ��....�� Client Project I D No (0 d/ - <br /> Sample Team Member(s) ku W <br /> , <br /> Lab Client Sample Air Date/ p No Type <br /> Number Identification Volume Time Sample Pres of of <br /> olleeted Type Cont C <br /> W.. 1 , Cont Comments/Hazards <br /> w` 11.2.0 UJ <br /> LAJ <br /> w00l <br /> r <br /> r <br /> i <br /> a <br /> i <br /> Relinquished by �T �, <br /> (Signature ! � � lb <br /> y DATE f TIME <br /> Relinquished by D TE TIME <br /> (Signature) y DATE <br /> TIME ; <br /> Relinquished by DATE TIME <br /> l <br /> (Signature) DATE TIME j <br /> Method of Shipment <br /> ¢i <br /> 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, d,am pore size 5)Charcoal tube 6)Silica gel tube 7)Water 8)Soil 9)Bulk Sample <br /> 10)Other 11)Other <t;� <br /> i- COPIES WHITE JOB FILE YELLOW PROJECT FILE PINK CLIENT <br />