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fl FACS Pave Smoke Impact Assessment <br /> Analysis Request Form (COO) <br /> Name&Address: PO/Job#: PJ G i 6/14/3 I Date:oa/.ao f 1cr ( <br /> Forensic Analytical Consulting Services, Inc. (LA05) Turn Around Time: <br /> 4900 Airport Plaza Dr. Suite 115 0 Same Day / 0 1 Day / 0 3 Day / 0 5 Day <br /> Long Beach,CA 90815 Analysis Type: <br /> Contact:Osmar Alvidrez 0 IAQ Particle Identification (PLM LAB) 0 PLM Opaques/Soot <br /> Phone: (310)668-5600 I Fax: (310)763-8684 0 Particle Identification(TEM LAB) 0 Special Project <br /> E-mail:WFSsupport-LA©forensicanal tical.00m 0 Limited Particle Identification with pH <br /> Site:PJ / LI'1//5 y9N30 5-4-4 ---S+ a:«-- Ai iE 0 Limited Particle Identification <br /> (Ja y.r 0.60%.,.,_ 09_ 471co 0 Carbonaceous and dad(opaque panicles aster ash components. <br /> / <br /> Comments: Hold Samples: Report Via <br /> El Yes 0 No 0 Fax El E-mail <br /> • <br /> Sample <br /> Sample ID Sample Location!Description Type <br /> T( 917 12,0, .( —(o^ae., /- ...1.) L-.l:/�... <br /> 'ra Pit g-Goe.-, - CON.Frv,4 'S1 <br /> 1;1) ti: 4r l,o Le - Floe.:.., r li F.ck✓ <br /> /e'l /lasted- lX-Were a.-- ' ( /:,.J•✓ -1-yey Lc/S'd <br /> IS 9,eCif e...., I - Co.i - .,1 aJj Fred- <br /> 7 c cal 73 <br /> -^fSt-1F...-.o <br /> 7 J('ref - i Er.n l 75 Ere. <br /> 'leg J1109 - 0-01-a is-{ S' (*Ili Pv. <br /> `re•i °li,co_ Pled-Rep...., - F(o.e ad) to ricer <br /> IrU SHOP -Con'Feer4 "Cr <br /> Semple Type:T•Tape,MV=Mlanvec,S•Swab,B=Bulk <br /> Sampled ByCA .,,l (Tea,.'et Date: c.2 fa`/->no' Tane:Various <br /> Shipped Via: O Fed d -y0 DHL ❑ UPS ❑ US Mail 0 Courier 3 Drop Off 0 Other: <br /> Relinquished g..:, �� Relinquished By: Relinquished By: <br /> Date/Time: Date/Time: Date/Time: <br /> Received By: tom- J Received By: Received By: <br /> Date/Time: .-0/ ct5sa efic Date/Time: Date/Time: <br /> Condition Acceptable? ( -Yes 0 No Condition Acceptable? 0 Yes 0 No Condition Acceptable? 0 Yes 0 No <br />