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�onir matiq i j➢l� ` ��r P <br /> 1 Client z�� E ,,_ American nvi ronmentWetwork HCl y ge of <br /> Address '� /'� z v 3440 Vincent Road,Pleasant Ht4523 <br /> Phone(510)930-9090 REQUEST FOR ANALYSIS/CHAIN OF CUSTODY <br /> F Contact N'-iv FAX(510)930-0256 Lab Job Number <br /> Alt Contact Lab Destination <br /> Date Samples Shipped <br /> Address Report To ' ' Send Invoice To Lab Contact b "� <br /> 2 3 Date Results Required -r <br /> Date Report Required <br /> Client Phone No _ 4SS 4 5 17 1 <br /> Client FAX No <br /> Send Report To 1 or 2 (Circle one) ANALYSIS <br /> Client P O No 1 4 5 ' 20 I 7—Client Project I D No <br /> Sample Team Member(s) ,., <br /> r <br /> Lab Client Sample y` -� Sample �o Type <br /> Number Identification of of <br /> Collected IType Pres Cont Cont fq Comments/Hazards <br /> VZA-C M vJ y< I z 4 5 <br /> 03A w - S i 3 <br /> d4 - 1 45 <br /> 0r, -C 1 $ S <br /> Oro A-G vJ 8 1 <br /> t77A - 9 -2 <br /> OSA C M e.'3- o - 2 1 S <br /> d w- t 3 Oa <br /> Relinquished by DATE TIME Received by DATE TIME <br /> (Signature} J ]If -Z �j> (Signature) <br /> RelinquishedJ DATE TIME Received by DATE TIME <br /> (Signature) / r f a _ CL � .5/) (Signature) <br /> Relinquished by DATE TIME Received by IM <br /> (Signature) (Signature) <br /> Method of Shrpment Lab Comments <br /> 'Sample type(Specify) 1)37mm 0 8 pm MCEF 2)25mm 0 8 jam MCEF 3)25mm 0 4 pm polycarb filter <br /> r 4)PVC filter dram pore size 5)Charcoal tube 6)Silica gel tube 7)Water 8)Soil 9)Bulk Sample <br /> 10)Other 11)Other <br /> COPIES WHITE JOB FILE YELLOW PROJECT FILE PINK CLIENT <br />