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Reporting Intgn+tati <br /> T Client c �� t., /1111ei 1cC11a �11V11 Ul1191G'111C1j t'VC'llt uric AE,(( �y <br /> Address U 3440 Vincent)toad,Pleasant Hill,CA 94523 ' Page� of <br /> C' Ste_ Phone(510)930-9090 REQUESTFOR ANALYSIS 1 CHAIN OF CUSTODY <br /> # Contact _✓.lid, 1� FAX(510)930-0256 Lab Job Number �s q I <br /> All Contact Lab Destination <br /> Address Report To Dale Samples Shipped <br /> P I Cha C Send Invoice To <br /> Lab Contac! <br /> 2 ley 3 ('cpa Date Results Required <br /> JGr�r�x f Date Report Required <br /> Client Phone No <br /> Client FAX No <br /> Send Report To 1 or0(Circle one) ANALYSIS <br /> Client P 0 No Ctienl Projecl I D No <br /> Sample Team Member(s) \ <br /> LabCltenl Sample Date/ <br /> Air <br /> Sample —Ty—pe— <br /> Number Identification Volume fType' Pres of ofC <br /> Collected <br /> Coni Conl Comments/Hazards <br /> Relinquished by DATE TIME <br /> (Signature) DA �,?/ - Received by DATE TIME <br /> —.- 7 z i0(�'� 1 010 (Signature) I��,I�� <br /> Relinquished by DTE TIME �^ f ! b U <br /> (Signature) r ___ Received by DTC TIME <br /> 64 U (Signature) <br /> Relinquished by DATE TIME r <br /> (Signature) Received by DATE TIME <br /> Method of Shipment (Signature) <br /> Lab Comments <br /> 'Sample type(Specify) 1)37mm 0 8 Wm MCEF 2)25mm 0 a pm MCEF 3)25mm 0 4 pm polycarb filter <br /> 4)PVC filter, diam pore size 5)Charcoal tube 8)Silica gel tube 7)water 8)Soil 9)Bulk Sample <br /> 10)Other 11)Other <br />