Laserfiche WebLink
�F'tl L Vi P%—a—T ff' .J-� <br /> PRECISION E NVIRO-TECH CHAIN OF CUSTODY <br /> ANDANALYSIS REQUEST DOCUMENT <br /> CLIENT DETAILS SAMPLING ' 1 ' 1 ' 1 <br /> Client: `5 V 1^^ id <br /> IIen W:CC I p"O � Sampler(s) P� ,� Rush Analysis: 5 Days _ 2 Days_24hrs <br /> y ��� <br /> 4S U/ <br /> Composite Sampler Setup: Subject to surcharge <br /> Customer Number: Date: A Time: QA/QC report required: yes no <br /> Address: <br /> ( 2 L_ P1 to Surcharge Field Sampler: If yes, To: State Client Other <br /> Time Milage: Lab number: 1 — I <br /> Phone: 1201) SAMPLE CONDITION <br /> a Sample Temperature: Celsus <br /> FAX: azo�) 941 - 2c 3 o <br /> c9 � <br /> a <br /> `° r.5 to O o .e <br /> c � <br /> (' vad <br /> Leaking. Broken. VOA Headspace; ?% 3b <br /> Project name: + rpoXy <br /> Custody Seal ( )yes ( ) no <br /> SAMPLE TRANSPORTATION ' <br /> o C7FLI N m <br /> Contact person: d o m ° M <br /> z �� z o <br /> c a a a <br /> )Ice Chest ()UPS ( )Fed Ex ( <br /> )Drop off <br /> SAMPLE • <br /> w o F(Sample Date Time t <br /> Location Description zANALYSES REQUESTED <br /> ( )O <br /> Number Sample Sample ther <br /> rq ih �;a, uji � -24Jil 1 Ov G N� — 5c - �;� 4- STLL dor 6k�o� ST/ _.-*Co e✓ <br /> -1 Pox C1►v,, IIw ib TEL dotf hyo —d C -FNP f <br /> 1 •+�Ir C�10 Srfl.�' Oji / 4'2$11 11;0a G P <TLLa Lp <br /> P <br /> CUSTODY <br /> Relinquished by: ` Date -*1ITimeA 24� Received by: r Dateime <br /> Relinquished by: Date Time Received by: Date Time <br /> Relinquished by: Date Time Received by: Date Time <br /> 3935 N. Coronado Ave. *Stockton CA 95204*Telephone(209)477-8105*FAX: (209)546-7497*Email:Petal545@sbcglobal.net*w-,vw.petallab.com <br />