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M "17R g Int NVAMMM Mw xw TEr W M1 Client K nrc�►fc(r►r E'nt�►rolinteniul tworkI <br /> Address G f hi r. 3440 Vinc.c ni Rudd Pleasant Hill CA 94523 I I ( Page of f <br /> at ► Phone(510)930-9090 REOUEST FOR ANALYSIS/CHAIN OF CUSTODY <br /> contact s i Iy FAX(510)930-0256 Lab Job Number <br /> All Contact FA q+r Lab Destination <br /> Date Samples Shipped <br /> Address Report To Send Invoice To Lab Contact <br /> Date Results Required -M-NOxKP 1 <br /> Date Report Required <br /> 11 Zh Client Phone No 4 I ' 3-7016 <br /> V Client FAX No 9 16 -L 3777 <br /> Send RepoA To OW <br /> 2 (Girds one) <br /> ANALYSIS <br /> Client P O No CUL-113'20 -003 UOsnt Project I D No � <br /> Sample Team Member(s) W, F L G40 � <br /> Lab Cheat Sample Air Date/ Sample No Type <br /> Number IdenGficatlon Volume Time Type* Pres of o `� l�� <br /> Collected Cont Cont Comments/Hazards <br /> M� I 11112`2 Hc(, D rt /& SPH E I'r le <br /> 51 <br /> L)ZA£ NIL MkbE oil t tiL 11 44 IL X ( c <br /> 111,4111. <br /> Mw -L tat <br /> A-9 X <br /> , <br /> (RelwxWished by (, _ DATE TIME Received by DATE TIME <br /> w fl R u0 (Signature) <br /> Rehngcestied by do D AIE TIME Received byAV I <br /> - A Ftt TIME <br /> , (Signature) } �� -C!J I y <br /> Relinquished by DATE TIME Received by ` l j DATE TIME <br /> (Signak") (Signature) <br /> oI Shrpmertt 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 finer, dram pore size 5)Charcoal tube 6)Silica get tube 7)Water 8)Sod 9)Bulk Sample <br /> 10)Other 1 t)Other <br /> COPIES WHITE JOB FILE YELLOW PROJECT FILE PINK CLIENT <br />