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�-3 3 f . <br /> Reporting Inform A� <br /> Amertcan Envcrortmenta etwork 1 r Page of <br /> 11 <br /> 1 Client I <br /> Address 3440 Vincent Road,Pleasant Hill,CA 94523 <br /> REQUEST FOR ANALYSIS/CHAIN OF CUSTODY <br /> ,ej, s Phone(510}930 9090 qD l�3[ <br /> Contact _X�3 - /��/X FAX(510)930-0256 Lab Job Number <br /> Alt Contact Z Qho C Lab Destination <br /> Date Samples Shipped <br /> Address Report To Send Invoice To Lab Contact <br /> 2 3 Date Results Required <br /> S24 Date Report Required <br /> 47 Client Phone No <br /> �Qr---•- — Client FAX No <br /> I — <br />� Send Report To 1 or 2 (Circle ane) ANALYSIS <br /> { <br /> ti <br /> Client P 0 No Client Project I D No <br /> Sample Team Member(s) <br /> i <br /> Lab Client Sample Air Date/ Sample No Type <br /> Number Identification Volume Time Type. Pres of of <br /> Collected Cont Coni Comments 1 Hazards l <br /> n(A5 1 <br /> �} 4� �` Z <br /> pL( i &U1111 V7,` D Z <br /> o" <br /> 7, -qnG� <br /> A 44 <br /> o`x, w 11 f,J <br /> I <br /> Relinquished by DATE TIME Received by DATE TIME <br /> (Signature) r ,�. r ! �',r (Signature) /� <br /> Relinquished by 11 DATE f [ TIME Received by I `r DATE TIME <br /> (signature) �' r` ! � ✓� f) _ 0``f ��� (Signature) 0,/ <br /> 16- Cy �� 3--I ria I <br /> Relinquished by DATE TIME Received by DATE TIME <br /> (Signature) (Signature) <br /> Method of Shipment Lab Comments <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, 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 Zia <br />