Laserfiche WebLink
Reporting Inf n <br /> 1 Client Alnel,!1 an f'llwl( nlne1 Network AE <br /> Address � 1440Vllto�ilt 16,1d,Plu.rti,utt Hill,CA 9452Page of <br /> 1'huni(510)930 9090 REQUEST FOR ANALYSIS I CHAIN OF CUSTODY <br /> Contact �/C� 1 AX(510)930-0256 arab Job Number <br /> Alt Contact Lab Destination CL' g2�.- <br /> GILIC13xAEWWO Date Samples Shipped_ <br /> Address Report To Send Invoice To Lab Contact <br /> 2 3 Date Results Required <br /> -�- Date Report Required <br /> b - — — Client Ph No QQ'� <br /> —--- Client F -� <br /> P Send Report To 1 or 2 (Circle one) A YSIS <br /> Client P O No � Client Project I D No r <br /> Sample Team Member(s) r <br /> Lab Client Sample Alr Date/ No T e <br /> Number Identrflcatfon Volume Time Srnle Pres of of <br /> Collected Type' Cont Cont IN Wffe <br /> 41) <br /> 7 — - Z- — ZZ 592— <br /> Relinquished by t , DAT TIME <br /> (Signature) Received by D T TIME1 <br /> / vL/ <br /> Relinquished by DATE (Signature) 2-Lt <br /> (Signature) r �� � E Received(Signature) <br /> ' DATE TIME <br /> Relinquished by DATE TIME <br /> (Signature) Received by DATE <br /> TIME <br /> (Signature) <br /> Method of Shipment Lab Comments <br /> luis at VO OCG l4�E41 S G <br /> GOOF)COMMON ��a���(�t j1jFl iQ�je .fy� 1 31mm 0 8 jam MCEF 2)25mm 0 8 pm MCEF 3)25mm 0 4 arm poiycarb filter <br /> {U �SPACL ABSFIr f1 r,L PV er dlam - pore size - 5)Charcoal tube 6)Silica gel tube 7)Wdtef 8)Soil 9)Bulk Sample <br /> - CV�;ll�ilf}E 11�� t0)Other - - - - 11)Other - - - - - --� <br /> r OPIES WI II IE lofi Fii F yh I OW PRC)IF('T FII E PINK (I IENT <br />