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Re orting I rmaUon 3 <br /> 1 �ent~ r-Qu R �_�_, ,, _ ( American Environmental Network AEN Page ( of <br /> Address _`��*a M L 3440 Vincent Road,Pleasant Hill,CA 94523 REQUEST FOR ANALYSIS/CHAIN OF CUSTODY <br /> Phone(510)930-9090 _ <br /> Contact Tt �; u FAX(510)930-0256 Lab Job Number (� 32 <br /> Lab Destination <br /> Alt Contact Date Samples Shipped �2 7-7 <br /> Address Report To Send Invoice To Lab Contact _ = o L4 k <br /> Date Results Required 1 —T '4 <br /> 2 - "`" `�-• 3 Date Report Required <br /> Client Phone No <br /> Client FAX No <br /> Send Report To 1 or 2 (Circle ane) ANALYSIS <br /> Client P O No _t S- ! J� Client Project I D No <br /> Sample Team Member(s) <br /> Lab Client Sample �atef No Type <br /> 3` <br /> 4 Sample <br /> of of <br /> Number Identification ume C llected TypeTime * Pres Cont Cont Comments 1 Hazards <br /> 7-7 h7 --3 F' <br /> -C W — 14 15 <br /> -C —7 <br /> OFA -( t6 W t i 4 . <br /> G-7A-C 1 <br /> A-c - � <br /> i <br /> i <br /> Relinquished by n, DATE TIME Received by , , DATE TIME <br /> (Signature) ,�( '� _ �., a •-7 (Signature) <br /> Relinquished to � ��. DATE TIMI= y ' ' ' 0�` `' TIME <br /> Received b �' ` <br /> (Signature) i[, t + ^,f '/ , T a <br /> rF ` 1 , (Signature) , .'i ' ✓ /° a r C%)-7 1 <br /> Relinquished by DATE TIME Received by DATE TIME <br /> (Signature) (Signature) , <br /> Method of Shfpment Lab Comments <br /> 'Sample type(Specify) 1)37mm 0 8 Nm MCEF 2)25mm 0 8 um MCEF 3)25mm 0 4 um polycarb filter <br /> 4)PVC filter, diam pore size 5)Charcoal tube 6)Silica gel tube 7)Water 8)Soil 9)Bulk Sample <br /> 10)Other f ther <br /> _ I♦ �PIES� JQI�YELL&ICTJMM PINKgJJ&TIIIIIIIIIIIIIIIIIj <br /> -� - <br />