Laserfiche WebLink
PRECISION ENVIRO-TECH CHAIN OF CUSTODY <br /> AND ANALYSIS REQUEST DOCUMENT <br /> CLIENT DETAILS SAMPLING REPORT INFORMATION <br /> Client: lM <br /> 1t o., k) l r/c P.-OL)J5 <br /> )c 5 Sampler(s): A71'.� Rush Analysis: 5 Days _ 2 Days_24hrs <br /> S U <br /> `, Subject to surcharge <br /> Customer Number: PC, <br /> N fi' QA/QC report required: yes no <br /> J� Comp Sampler Set Up Date: Time: <br /> ` ddres r 1 .2— C� / "r I If yes, To: State Client Oth4pr <br /> Time: Mileage: <br /> V ; [ <br /> C75 Lab number: <br /> D' <br /> Phone: <br /> FAX: o <br /> a s m ; ° z E+ <br /> ° > a <br /> Projectname: CQ�i+�e� 0.i, Fq 4y 0 <br /> .q a <br /> z <br /> Contact person:�� ,` 'S 40 m <br /> 0 r� <br /> W a <br /> ° a w 333 U <br /> ° d <br /> SAMPLE INFORMATION <br /> `° a o mC73 0 N as +� <br /> Sample Date Time a E a a aa m x <br /> Number Location Description Sample Sample z'> w m 3 a V <br /> 1- P bon He ✓ -7-11 I/'50NP WW — - — <br /> ICUSTODY <br /> 4-7--11 IZ'Sb 2 . <br /> Relinquished by: Date Time Received by Date Time <br /> 777 <br /> Relinquished by: Date Time Received by: Date Time <br /> Relinquished by: Date Time Received by: Date Time <br /> PRECISION ENVIRO-TECH 3935 N. Coronado Ave. * Stockton CA 95204* Telephone(209)477-8105 *FAX: (209) 546-7497 <br />