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� <br /> �ing f i -on r w�Ame an�viro nt etw Page of 1_ <br />' 1 Client 3440 Vincent Road Pleasant Hill 94523 <br /> Phone(s lo)93o-9a90 <br /> Address REQUEST FOR ANALYSIS/CHAIN OF CUSTODY <br /> ' <br /> Contact _�+�C-�+J Uc FAX(510)930-0256 �-3t 5 3 Lab Job Number <br /> CAft ontact <br /> `��,} Lab Destination <br /> tti` S�� Date Samples Shipped d11 <br /> Address Report To Send Invoice To 1 Lab Contact <br /> pp RDale Results Required <br /> 2 3--SmA - 4.S &6eie- Sa��, IM S 03 kn�s e. Dale Report Required 1 Client Phone Phone No <br /> Client FAX Z0--572-ZlZS" <br /> ANALYSIS <br /> Send Report To or 2 (Circle one) 'Tar ywj i T" . <br /> Client P O No 91CIRClient Project I D No 6 Z59 G flb0 1— 01 <br /> Sample Team Member(s) ~ <br /> Date/Lab Client Sample Air Time Sample No Type 10 a <br /> of of <br /> Number Identification Volume Collected Type Pres Cont Cont E4Comments/Hazards <br /> 1►. I HCkas 2{, sal <br /> Mw <br /> Mw -3 ug rbs7 1 4 1 ✓ .. <br /> Mvi _ 4 I" <br /> r --� z� ✓ ' <br /> 7 t�- ,& WtA MAM io <br /> I Ar Alln s <br /> Ikeoly tB <br /> 444- <br /> R,,I,r,qulshed by � DATE TIME Received by ATE TIME: <br /> (Signature) f .`f ( Z,7 t (Signature) 03 Z r <br /> ZRelinquished by DAT TIME Received by bAT ME <br /> (Signature) (Signature) 3 , <br /> Relinquished by DATE fIME Received ATE TIME <br /> (Signature) (Signature) <br /> Method of Shipment Lab Comments <br /> 'Sample type(Specify) 1 j 37mm 0 8 um MCEF 2)25mm 0 8 pin MCEF 3)25mm 0 4 pm polycarb filter <br /> 4)PVC triter, diam pore size 5)Charcoal tube 6)Silica gel tube 7)Water 8)Sod 8)Bulk Sample <br /> 10)Other 11)Other <br /> COPIES WHITE JOB FILE YELLOW PROJECT FILE PINK CLIENT <br />