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PRE SIGN ENVIRG-TECH ACHAND AINIO OF S REQUESTDoODYT <br /> CLIENYe ♦ 1 <br /> ' REPORT INFORMATION <br /> /- Rush Analysis: 5 Days _ 2 Days 24hrs_- <br /> Client: �S� �T / �Y17 �'/ S/P�� Sampler(s): [YK �/ I <br /> / _N Y, ` O ee�/ h 7- Subject to surcharge <br /> Customer Number: �L �J z� �i - QA/QC report required: yes no <br /> Comp Sampler Set Up Date <br /> Address: So f S „A Ave Time: � 4.7 If Mileage: If yes,To: State Client Other <br /> S),o CA-0 Lab number: F / 3 cq 3 —01 —61 <br /> Phone: <br /> FAX: `� �� �� m o <br /> �? m ti 3 0 <br /> ti � <br /> z ° Uj Q x <br /> y M <br /> Project name: ��� y d F A v <br /> �3 01 F z <br /> Contact person: o m M v? <br /> E z b z o b <br /> Ftiy z W � � a �v <br /> c w 3F x o m <br /> INFORMATION E , c i <br /> SAMPLE <br /> Sample Date Time F¢ a m x <br /> Number Location Description Sample Sample F z' <br /> 1 q G P S X <br /> i, • S , 1 , 1 X <br /> 3 2 ., 4-c <br /> 77-77 CUSTODY -7 - 17 <br /> Relinquished bX Da 42 s Time J Received by: Dat ime { <br /> Relinquished by: Date Time Received by: Date Time <br /> Relinquished by: Date Time Received by: Date Time <br /> PRECISION ENVIRO-TECH 545 E. Cleveland, St. Suite A* Stockton CA 95204 *Telephone(209) 462-0892 * FAX: (209)462-7935 <br />