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1. CH n n mapnn Ariel ican Environmental Network AEN Pago—L of <br /> C 'r}�s�t. - i <br /> Ad res Pfd It•0'e, I ��4h '" 3440 Vincent Road,Pleasant Hill.CA 44523 nEOUEST FOR ANALYSIS!CHARD OF CUSTODY <br /> S r X 459,5 3 ..ltd E Phone(510)930-9090 ' Q <br />' <br /> FAX(5 10)930-0256 Lab Job plumber ---f-(0� - <br />'r con ci• Lab Destination <br /> NLI °ni ;`" � �k r Date Samples Shipped <br /> Address Fieporl To:' ` 'r"r i } Sond Invoice To, Lab Contact* -- --- <br /> 2, { t i Date Results Required <br /> t Lt) ` ] Gt S - - -_ table_ 4 L } -1- ----------- - -- Dale Reporl Required <br /> r ° �' Client Phone No <br /> i ��,- - -- Ctlonl FAX hta <br /> r ANALYSIS <br /> Send Reporl To: 3 or 2 (Circle ona) , <br /> Client P D.No° ' Chant l'ro)eci 10 No <br /> Sample Team Member(s) <br /> Lab CgentSample Air Ohne atel Sample Pres. 0# Type <br /> Number4umber ldellttilw((an Volume The <br /> Type Cont, cont,nComments 1 Hazards <br /> )01 91 7 IjCI_ Z vaF5 <br /> 3 Io' 30 <br /> n <br /> 1A tj I T► <br /> 0 !t 110- <br /> r�. � <br /> U t v <br /> 0 3 - <br /> 1 t "j 10 <br /> I `orb <br /> Retlnqulshed by DATE TIME Recelvod by QATE TIME <br /> (Signature) -Z(1-% (Signature) �- <br /> Rotinquished by DATE w Received by DATE IME <br /> (Slgnatura) / r (Signature) 2,0-1 G 1 y qr <br /> Relinquished by DATE TIME Rocelved by DATE TIME <br /> i (Signatura) (Signatut <br /> Method of Shipmonl Lab Comments <br /> 'Sample type(Specily) 1)37mm a U pm MCEF 2)25mm 0 6 pm MCEF 3)25mm 0 4 pm potyca►b tiller <br /> 4)PVC filler, din,rt pore size 5)Charcoal It Vo B)Silica vel lube ZpWater 8)Soil 9)Bulk Sample <br /> 10)Other +1I or <br /> L ti COPIES WtaTE JOGRE' YELtOP-ntOJECTFU PUNK CLIENT - <br />