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Reporting Information: <br /> r S�yG��ris / �YI�r G American Environmental Network AEN 3 Page 1 of <br /> 1. Client: 3440 Vincent Road Pleasant Hill,CA 94523 3 ti S <br /> Address: .6 7W 7 S?/ri-e, 7 f ,i REQUEST FOR ANALYSIS 1 CHAIN OF CUSTODY <br /> c� <br /> :„� ,��� Phone(510)930-9090 <br /> Contact: t m ( e,r�r FAX(510)930-0256 Lab Job Number: <br /> Alt.Contact: hLi r5 S __ Lab Destination: - <br /> Date Samples Shipped: <br /> Address Report To: Send Invoice To: Lab Contact: <br /> 2 3 Date Results Required: <br /> Date Report Required: <br /> CGu Gr,� ' �1 ' <br /> Client Phone No.: IN UC) - <br /> Client FAX No.: y7) -72 K G• <br /> ANALYSIS <br /> Send Report To:� 2 (Circle one) <br /> Client P.O.No.: / Lf Client Project E.D.No.: > <br /> Sample Team Member(s) <br /> Lab Client Sample Air Date/ Sample. of Tope <br /> Number Identification Volume Time T e� Pres. "- Comments/ Hazards <br /> Collected �l'� < Cont. 'Cont., iL <br /> 0V-6 -Z 1 !r. 1 r V� <y <br /> A0 W <br /> I <br /> I <br /> i <br /> Relinquished by: ' DATE TIME Received by: DATE TIME <br /> (Signature) e Z f CR$GCJ (Signature) <br /> Relinquished by-I") 7DATETIME Received by: — `� DATE / TIME <br /> -i I <br /> (Signature) 1 `ltr' I(\ Co'� 17- 2-1{ !r- — -•3'c7 (Signature} () <br /> Relinquished by: , DATE TIME ry Received by: vim/ f DATE TIME <br /> (Signature) ( r 7 ��rr (1�'�— (Signature) <br /> Method of Ship nt Lab Commen{s' :+ <br /> IBJ SCM yLeY . sT ..��J r <br /> S4mp6 type(Specify): 1)37mm 0.8 um MCEF 2)25mm 0.8 Nm 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 S tr.YG-1' OCA.- <br /> Other A1C,^t 1 2JG <br /> ':j• ,:•;• <br /> COPIES: WHITE-JOB FILE YEL'•�'11. PROJECT FILE PINK-CLIENT <br />