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' I I i II I dnAI& OV u Ggi-ODS I 1 1 <br /> PRECISION ENVIRO-TECH ANDANALYSISREQUESTDOCUMENT <br /> hlt: 11 www Precision Luh. Com <br /> CLIENT DETAILS REPORTINFORMATION <br /> �Q <br /> Sampler Rush Analysis: 5 Days _ 2 Days_24hrs <br /> Client: ��0 . GNU//�, � ��"� <br /> Subject to surcharge <br /> Sam <br /> Customer Number: QA/QC report required: yea no <br /> Comp Sampler Set Up Date:— Time: <br /> Address: Time: Mileage: <br /> If yes,To: State—Client —Other _ <br /> Lab number: ?6r#069'-61 o2 ,o3 .Oy.05� o <br /> Phone: x <br /> FAX: a 9 a F: <br /> s z 8.'7 <br /> $ /In <br /> Project name:2,9eS Ffee lltirYi d SY s 4-4 <br /> Z V <br /> Contact person: TIM. m <br /> W r 4 /01 za„9�rX3m x <br /> SAMPLE <br /> Sample DteTi <br /> Number Location Description mpeSamplea <br /> Iz 31 T <br /> )2)31 135 <br /> 3 LS N 40 3 2 <br /> a <br /> s Pe G€K Z 3 1Z0 s <br /> l S/Cn/cc/2 3 i a l Z° <br /> 777 CUSTODY <br /> Relinquished by: DateTime Received by: Dat 3✓ Time <br /> Relinquished,.bY_ Date _Time Received by: Date Time <br /> Relinquish11 ,d.y : Date _Time Received by:. Date Time <br /> PRECISION ENVIRO-TECH 2040 Z arding Way Suite B *Stockton CA 95202*Telephone(209)462-0892*FAX:(209)462-7935 <br />