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. sYa�saq_� <br /> Reporting Infor <br /> 1 Client Amel scan Envtronmenta etwork AEN <br /> Address 3440 Vincent Road,Pleasant Hill,CA 94523 Page of <br /> �2 CJ Phone(510)930-9090 REQUEST FOR ANALYSIS 1 CHAIN OF CUSTODY <br /> Contact ! SCJ FAX(510)930-0256 Lab Job Number t <br /> Aft Contact Lab Destination <br /> Date Samples Shipped <br /> Address Report To Send Invoke To Lab Contact <br /> 3 Date Results Required <br /> _ Date Report Required I <br /> Client Phone No <br /> Client FAX No <br /> Send Report To 1 r 2 {Circle one) ANALYSIS <br /> Client P O No Client Project 10 No <br /> Sample Team Member(s) I-,e4 lJ U <br /> Lab Client Sample Dale/ <br /> p AIr sample Tote <br /> Number Identificallon Volume f <br /> Time Pres of <br /> Collected Type Conl Coni <br /> Comments 1 Hazards <br /> c <br /> Relinquished by DAT TIME <br /> Received by <br /> (Signature) /� r'`� y �,c, (Signature)e) �� DATE TIME <br /> Relinquished by DATE TIME <br /> (Signature) �� - `11 7 Received by s DATE TIME <br /> (Signature) _ <br /> Relinquished by DATE TIME Received by DATE FI ! <br /> (Signature) TIME <br /> (Signature) <br /> Method of Shipment Lab Comments <br /> I <br /> `Sample type(Specify) 1)37mm 0 8 pm MCEF 2)25mm 0 8 pm MCEF 3)25mm 0 4 pm 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_ 11)Other <br /> COPIES WHITE J08 FILE: YELLOW PROJECT FILE PINK CLIENT <br />