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HPnnrngg Ininrmation: /,-7 1 1 <br /> .— '— — ne ,-i E - ion- 'tai '-w( - L1 Pages <br /> 1. Client: Fi= <br /> f 3440 Vincent Road,Pleasant Hill,CA 94523 <br /> Address: Phone(510)930-9090 REQUEST FOR ANALYSIS!CHAIN OF CUSTODY <br /> Contact: FAX(510)930-0256 Lab Job Number: <br /> pp,�. Lab Destination: E t%L <br /> Alt.Contact: f'"7�b�✓1 &'✓5 - <br /> 1 il6 Date Samples Shipped: b-1-7-12 <br /> Address Report To: Send Invoice To: `-11' Lab Contact: <br /> 2 3 i Date Results Required: Z J —4)-7 <br /> Date Report Required: — — —7 <br /> Client Phone No.: <br /> Client FAX No.: <br /> ANALYSIS <br /> Send Report To: 1 or 2 (Circle one) <br /> Client P.O. No.: ��b� Client Project I.D.No.: 40�� � <br /> Sample Team Member(s) Q <br /> Lab Client Sample Air Time Date/ Sample No. Type m <br /> of of <br /> Number Identification Volume Collected Type` Pres. Cont. Cont. Comments/Hazards <br /> b-13--q-7 Cvc'o i 1?D <br /> - din <br /> AV0k <br /> Relinquished by: DATE TIME Receivedb AT TI <br /> (Signature) , b-(7 -`t'7 �v (Signature //V 9-') v p <br /> Relinquished by: DATE TIME Receive D E IME <br /> (Signature) (Signat ) <br /> Relinquished by: DATE TIME ReceivedDATE TIME <br /> (Signature) (Signature <br /> Method of Shipment Lab Comments <br /> 'Sample type(Specify): 1)37mm 0.8 Nm MCEF 2)25mm 0.8 Nm 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 />