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Reposlsng Intor t`�Yl2L'rican,� nvirf)�'�i7dG'f�r�f���V4'lJrr"�t AEN i Gltent L _} i� Page of <br /> 3440 Vinci Road Plant lid3,Cr195.'x <br /> p,�m� l .U � REOEIEST FOR ANALYSIS 1 ClU11M OF CUSTODY �? <br /> T Phalle(5 10)930-9090 <br /> r If,y FAX(510)930.0256, Lab Sub number -I � <br /> Contact T c� <br /> Late Destination <br /> Alt Conlaciak� l Date Samples SfarPPed - -- - <br /> Address Report To Send Invaroe To Lab Contact 2 <br /> / Oate EWsults Reqwred rtia <br /> x 1 1 g, 2." [�2 - yr { -- '� Date Report Required <br /> dk Gltent Phone No2rn <br /> v Client FAX No <br /> ANALYSISSend FtepnR To t Q<,/2 Gtrcw one) :3> <br /> v � <br /> Client P 0 No Client S'rplAct t iJ No <br /> Sample-Team Member(s) <br /> • tr1 <br /> Lab Clent Sample } Air � �` a Sample, t v Type r <br /> Number ldentsttcatton Volume <br /> Time Type' Pres of of <br /> netted Com Gon1 Canlrtents/Hazards rz <br /> A 97 <br /> - --- -- I-- ' _ T <br /> _F21 W <br /> l.,At�M <br /> 0366 fflWL7--- <br /> - x <br />� ro <br /> 01 <br /> a <br /> QD <br /> - - W <br /> CD <br /> CD <br /> El )�M <br /> Rebnqutshed S TIME Received by DAIE TIME <br /> (Signature) .z `� (Srgnaturel i y `] D a <br /> T Tl�ijlE <br /> lgehngwsfred b31 I Received by DATE 1TIM?00 <br /> E�y <br /> (S"twe) ( •1 PO (Srgnaturel _ '->A-tz� 1 `T C 0 <br /> Rellinquishedblr DATE TIME Flecewedby DATE TIME <br /> (ftnalure) (Srgmdure) <br /> Method of Sttirp nt 1 Lab Cornn�nts IJ -z7 <br /> Q <br /> 'Sample type(Specify) 1)37rrim 0 B pfn MCEF 2)25mm 0 8 yrn MCEF 3)25rrtrn 0 4 pm pofycarb filler <br /> 4)PVC filler, dram pore sme. --_ 5)GhamDal tube 6)Silica gef tube 7)Water 8)Sari 3)Bulk Sample <br /> 1 D)orttor_ - - - -- - 1 I)Other - <br /> c.opo IVF'IlTE JOB FILE YELL06 PRWECT FILE PINK CUENT <br />