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i C'rlAN 10F 0018 t JJ'l I PRECISION;ENVIRO—TECH � a <br /> CLIENT INFORMATION REPORT`INEORMATION " <br /> Customer ID: ADGEO <br /> Rush Analysis 5 days: r 2 Days: r 24 Ire: <br /> Company Name: Advanced GeoEnvironmental, Inc. Subject to Surcharge <br /> Adress: 4005 N. Wilson Way QA/QC report Required: Yes: r No: r <br /> City: Stockton If yes,To: State: r Client: r Other: IEi <br /> State: CA. LAB SAMPLE NUMBER: y�5 57 -cI/ ^Z 6.3 G:i/ QS n/ <br /> Zip Code: 95205 ! - / - - -- / - ! ! <br /> Phone: (zos) 467-1006 SgMPLING INFORMATION,' <br /> Fax: (209) 467-1118 <br /> Contact Person: William Little Sampler(s): i'I Employed by 6 <br /> NI(� Comp Sampler Setup Date: Time: <br /> Sampling Charge: Yes: r No: N) <br /> ` If Yes -Time Travel to Site: Mileage: <br /> u SAMPLE INFORMATION `° °i ' ' " "• ' <br /> Sample — Location Description Date Time Type of Sampling Type of Sample Matrix Preservative- ANALYSES REQUESTED <br /> No. Sample Sample Container <br /> /'7I{sI)I/ _ ♦y� 1 CompositePlastic/Glass <br /> ✓=1M1�' Ilei - l Ie 1� �� Grab r Cl/1t1� IV� 11VV IY��1✓V 1!)V" `s/ l ✓ ' V I .[./ <br /> -__ — Composite Plastic/Glass - - --- <br /> 1 /,i� Composite Plastic/Glass (/ <br /> ._l l Il-� I t - Grab of <br /> `I <br /> Q Composite P...aaalastic/Glass <br /> II I:oU rab -- �-I II <br /> Compositeplastic/Giese - -- - rJll//\ IGAS , ^'�l/' , DV <br /> ( WiT <br /> I I O I' I- Grab <br /> CUSTODY �� ��YG�b Y� �' k L''v� , DIV Iws D149* f� <br /> Relinquished by: —Date—Time—Received by: Date !ia--//11//XXll// Time <br /> Relinquished by: —Date—Time—Received by: Date Time VF <br /> Relinquished by: —Date—Time—Received by: —Date—Time <br /> PRECISION ENVIRO-TECH 2040 E.HARDING WAY, SUITE B STOCKTON, CA. 95205 <br /> PHONE: (209)462-0892 FAX:(209)462-7935 E-MAIL:JONL1597@AOL.COM <br /> Pink-Field Copy White-Report Coppy Yellow- Laboratory Copy <br />