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It porting inlorma <br />� . ,.,_. <br /> Allrc J rc 1f �N <br /> Page I <br /> of <br /> Client �� <br /> Address +•L- r.� 1440 Vincent[toad Pteacanl HII! CA 94523 REQUEST FOR ANALYSIS I CHAIN OF CUSTODY <br /> N'+o$ea a [A 4535! Plane(51f1)9�0 91191) < _ W,��, „ <br /> I AX 1510)9311 11?56 i 7� Lab Job Number �- , <br /> Contact �C� �4K /�<<<-'^ �' ,1 <br /> Alt Contact ,�e•r►•+�- �ow.s�v Lab Destination tit« �•^ y t <br /> Date Samples Shipped <br /> dress Report To Send Invoice To Lab Contact �i11 S <br /> 3 <br /> Dale Results Required 'T <br /> .. �. <br /> Date Report Required <br /> Client Phone No 'Z a4 -S7 9_7,2.2 t <br /> Client FAX No 2.6-i•- 5-79 -7-Z25 <br /> ANALYSIS <br /> id Reporl Ta 1 or 2 (Circle one) <br /> I�f�/.y. h <br /> ant P O No AT 9 9064 _B - Client Project I D No i 1 ,01 <br /> Tiple Team Member(a) L 4"�`v^"'•`^ <br /> Lab Client Sample Air Time Sample No Type <br /> umber Identification Volume of of <br /> Collected Type* Pres Cont GO Comments I Hazards <br /> - AWa " 7-5 S' f.--A c X x <br /> f i?- • 3 s s' .: �s •rte )< <br /> tom- ASO 1 - 1V ' <br /> 1 Z4' I6b + ?C 6 TAM___r.1 <br /> P- - 3c>r 14,41 ) %K X <br /> r- - Lo� 3 tl bis ?CX x r►Ye>c k, L c- <br /> A x - ISS' u+y s + X <br /> - .�s- s' •z t=s g t X I Lta-A 6 I-,3 trr- <br /> F - z 9.5 X x <br /> — x "AM <br /> -�� r��S��"_45.5' — 3•���9-Its �___ ---�-- I — �- — — -- —_ - -- �,�.�.�.1� T.���t <br /> 5 g -- 1 SV <br /> Imquished by DATE TIME Received by DATE TIME <br /> gnalure) ��..,. `? �s �� 32 l�d (Signature) <br /> linquished by TIMEReceived DATAy TIME <br /> gnalure) ( (SignaturfICT 3 z <br /> linquished by DA TIME Received DA E TIME <br /> gnature) -$- /9 S (Signalur - I`► <br /> tthod 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 potycarb filter <br /> 4)PVC IEiler dram, pore size 5)Charcoal tube b)Silica gel tube 7)Water a)Soil 9)Bulk Sample <br /> 10)Other 11)Other <br /> COPIES WHITE 308 FILE YELLOW PROJECT FILE PINK CLIENT <br />