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Reporting Infon _ American Environnientc, Network AENPage t Z <br /> of <br /> 1. Client: 3440 Vincent ILoad, Pleasant Ilill,CA 94523 <br /> Addr,'ess: Plume(510)930-9090 REQUEST FOR ANALYSIS/CHAIN OF CUSTODY <br /> FAX(510)930-0256 ' Lab Job Number: 8 <br /> Contact: �- 1 S -� Lab Destination: <br /> Alt.Contact: ,i i! I :, .1` Date Samples Shipped: <br /> Address Report To: Send Invoice To: Lab Contact: <br /> Date Results Required: <br /> A") 3' ) =' c' Date Report Required: <br /> Client Phone No.: <br /> Client FAX No.: <br /> ANALYSIS <br /> Send Report To: 1 or 2 (Circle one) Pe-� -i C C'� <br /> )int P.O.No.: Client Project LD.No.: <br /> /0(24 1-1Sample Team Member(s) <br /> Lab Client Sample Air Date/ Sample No. Type <br /> Number Identification Volume Time Type, Pres. of of Cont. Cont. <br /> Collected Comments/Hazards <br /> s1L.Y177 1!5 1/ <br /> Relinquished by:�' j DATE. TIME Receiv@d bye DATE TIME <br /> (Signature) - _ !d.�l ��/ (Signature) C=l.�i✓dee. Z-01/ <br /> Relinquished by: DATE TIME Received by: DAYE 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 />