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Reporting h formation tl` ''� � _ I I <br /> p g � U American Lnvirorzraiej�tccl Network t��1� Page of <br /> 1 Client' 3440 Vincent Road,Pleasant lull,CA 94523 <br /> Address � REQUEST FOR ANALYSIS 1 CHAIN OF CUSTODY <br /> Phone(510)930-9090 M r ? 2-2— <br /> giL= FAX(510)930-0256 Lab Job Number <br /> Contact RIA I I ea Lab Destination <br /> All Contact Date Samples Shipped <br /> Address Report To Send Invoice To Lab Contact .Y <br /> Date Results Required <br /> 2 3 .m oIA-77 Date Report Required <br /> Client Phone No <br /> Client FAX No <br /> aANAIY,91S <br /> Send Report To�1or 2 (Circle one) <br /> Client P O No �`_ff�'"' � - Client Protect I D No '� �Sample Team Member(s) ofLab Client Sample Air me Sample prey of No ToeNumber Identification Volume Collected Type Cont ContComments 1 Hazards <br /> C 2 k5 <br /> 2s5 <br /> DATE TIME Received by DATE TIME <br /> Relinquished by(Signature <br /> l�J <br /> DATE TIME Received by DATE nn TIME <br /> Relinquished by (Signature) 2 `i <br /> (Signature) S <br /> DATE TIME Received by DATE TIME <br /> Relinquished b/ (Signature) <br /> (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 6)Silica gel tube 7)Water 8)Soil 9)Bulk Sample <br /> 10)Other Other <br /> rnPiFG F 10i YFIZw <br /> 0IFrJJJfi PINK CI IFNT <br /> t� t• 1� <br />