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ing h tion: L <br /> 1. Client: ptE� ./I?(., « ..11l ILIFL V il'Oi1.,.-1ltct. . I-,tw-, ,, lig Payc <br /> Address: 3440 Vincent Road,Pleasant Hill,CA 94523 REQUEST FOR ANALYSIS/CHAIN OF CUSTODY <br /> Phone(510)930-9090 F6y D <br /> �.�� YCIoC' FAX(510)930-0256 Lab Job Number: <br /> Contact: U <br /> Lab Destination: <br /> Alt.Contact: Pvb+.n b4eu <br /> Date Samples Shipped: <br /> Address Report To: Send Invoice To: Lab Contact: <br /> 2 41l 3 ' Date Results Required: <br /> Date Report Required: IV <br /> Client Phone No.: <br /> Client FAX No.: <br /> \ ANALYSIS <br /> Send Report To: 1 r 2 (Circle one) <br /> �: -1 L--i�}1 '� Std--r 4cq-1• D I g <br /> Client P.O. No.: Client Project I.D.No.: IL` <br /> Sample Team Member(s) 4,7 <br /> Yp <br /> Lab Client Sample Air Date/ Sample No. T e <br /> Number Identification Volume Time Type. Pres. of of �7 a �� Comments/ Hazards <br /> Collected Cont. Cont. Il 4 <br /> + -7 LoL-b b POS CLac <br /> r <br /> 7-1 `1 I-P 0-VICL uAdpl <br /> Relinquished by: DATE TIME Received by: / DATE TIME <br /> (Signature) <br /> S- "� /y3 (Signature) 9 <br /> Relinquished by: DATE TIME Recq' y: DAA TIM�'j <br /> (Signature) t 7 / (Signature) <br /> Relinquishedby: D E 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 6)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 />