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Ming tt'hon <br /> 1 client i �meM n Mtronmnta twoT �� ! Pag�' of <br /> Address 3440 Vincent Road,Pleasant Hill, 4523 Phone(510)930-9090 REQUEST FOR ANALYSIS/CHAIN OF CUSTODY <br /> Contact FAX(510)930 0256 Lab Job Number <br /> Alt Contact Lab Destination <br /> Date Samples Shipped <br /> Address Report To Send Invoice To Lab Contact <br /> 2 Date Results Required <br /> 3 Date Report Required <br /> Client Phone No <br /> Client FAX No <br /> Send Report To 1 or 2 (Circle ane) ANALYSIS <br /> Client P d No R 3o'3 36 0 Client Project I D No 413 <br /> Sample Team Member(s) <br /> Lab Client Sample Air Cate/ Sample No Pres of Tope e� <br /> Number Identification Volume Time Collected Type* Cont Cont ,C Comments/Hazards <br /> i=P-..- - 25�5 e B COLD I VOA 900:3360 — j <br /> P -- M -- 30.5 1 <br /> Relinquished by DATE TIME Received by D T TIME <br /> (Signature) +///go f (Signature) <br /> Relinquished by DATE TIME Received by /D*E TIME <br /> (Signature) (Signature) <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, diam pore size 5)Charcoal tube B)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 <br />