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V11L111l Vl' VlJO1V1J1 <br /> PRECISION ENVIRO-TECH ANDANALYSISREQUESTDOCUMENT <br /> =7 <br /> P • • • <br /> 1 _ /� �] 1,L /� ' Rush Analysis: 6 Days _2 Days_24hrs <br /> Client: ge* o 6 /CIAA-( L Sampler(a): (✓ �(� <br /> ((11 , Subject to surcharge <br /> Customer Number: 25 i n 4 y QA/QC report required: yes no <br /> Comp Sampler Set Up Date:— Time: <br /> C <br /> Address: S:14 2 t• • wn DSOO /–p Time: Mileage: If yes, To: State _Client _Other <br /> ACAM{I W ) C q S27 i� Lab number:PC 'S'6 99–C)/_'C).2" 03 <br /> hone: ( 1 e^1l 3(e S( _ 1 m <br /> 4JC) 1 <br /> rnx: 5 As AGodES <br /> o " <br /> ; a <br /> m � <br /> ax <br /> Project name: <br /> S <br /> m <br /> a 'so L4 CQ <br /> Contact person: a `syy g <br /> SAMPLE • • she 3 e aha <br /> atieenie z oSample <br /> Number Location Description sinP semP <br /> I II'MrX WLST EIV OF iAOK 3I0 2!5q G Or 0 S <br /> .2 IVVTVT EAST END OF tANK- 3 Iv ',OS G ror 5 X <br /> 3 SvocY- rLt 1 'Wgr .311 D ' 10 61 Mr N S K <br /> Relinquished b ISate4_0Time3�eceived by: Date— 6 Time 5!/(D <br /> Relinquished by: Date _Tune Received by: Date Time <br /> Relinquished by: Date _Time Received by: Date Time <br /> PRECISION ENVIRO-TECII 2040 E. Harding Way Suite B * Stockton CA 95202*Telephone(209)462-0892*FAX:(209)462-7936 <br />