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7- <br /> Reporting Inforr, �: kAEN <br /> American Environmenta� etwork <br /> �� Page—-� of <br /> 1. Client: V ' 3440 Vincent Road,Pleasant Hill,CA 94523 <br /> Acdress� Phone(510)930 9090 REQUEST FOR ANALYSIS/CHAIN OF CUSTODY <br /> FAX(510)930-0256 i`-3� 5 4 Lab Job Number: U1 7 6 y <br /> Contact: Lab Destination: <br /> Alt.Contact: ' ` 7r S J K R } $ <br /> `g Date Samples Shipped: <br /> Address Report To: Send Invoice To: - }, - Lab Contact: <br /> Date Results Required: <br /> 3^ _�-t/L��' '— Date Report Required: <br /> v f r n �f. >,,, �N 1�: L Client Phone No.: <br /> Client FAX No.:14 E -,1� �1�G�`1 <br /> ` ANALYSIS <br /> Send ReportTo: 1 orf 2, Circle one) <br /> nt P.O. No.: Client Project I.D.No.: <br /> Sample Team Member(s) 5+''��1 n1 C4' r7` 1 i- i�C C'- (� � 0 � h A/ <br /> e-f o cl <br /> Date/ No. Type < ^1 t1l"'i be F5 <br /> Lab Client Sample Air Time Sample Pres. of of <br /> Number Identification Volume Collected Type Cont. Cont. O V Comments/Hazards <br /> VA <br /> /94�07 1§00 Z1 "41 A11 ,411, <br /> V <br /> _ �6 ✓ v <br /> DL 14111 c <br /> _ la AchiVe- <br /> A Y92 A Lo e <br /> i 'GA- I c <br /> t ' V �o A,' it'r. <br /> J1 If Ile) /uuv e a <br /> Relinquished by: ,,�i _ DATE TIME Received by: �.� DATE / TIME <br /> Fav"I f 'U`/ `f g (Signature) 6 !- L,�, <br /> (Signature) % f _.f �, __.. <br /> Relinquished by: DAT Received by: DATE TIME <br /> (Signature) (Signature) <br /> Relinquished by: DATE 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 />