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PREEISION ENVIRO—TECH C <br /> NOF CUSTODY <br /> ANALYSIS REQUEST DOCUMENT <br /> 5 htt: // www Precision Lab. Com <br /> 70ient- .� VA 4 {) C.7� zo <br /> 71RuAnalyses:5 Days_2 Days_24hre <br /> Sampler(s):r�/ a+./ i <br /> Subject to surcharge <br /> Customer Number: <br /> Comp Sampler Set Up Date:_ Time: QA/QC report required: yes no <br /> Address: Time: Mileage: If yes,To:State Client Other <br /> Lab number -01,0"F 404 �ofo it-if <br /> r one: <br /> l~ ll a <br /> FAX: <br /> Project name: ' �a <br /> Contact person: Y% g � R <br /> x <br /> Sample b °i <br /> Number Location Description Date Time s (� <br /> Sample Sample <br /> 1 SP— / I-15• 13S Cc 1Mr s +t <br /> i, <br /> S -Jq-- <br /> S 5 i: 96 <br /> sr� <br /> 'aa x w <br /> 5rst :o <br /> Relinquished by: Date Time Received by: a r ime <br /> Relinquished by: Date Time Received by: Date Time <br /> Relinquished by: Date Time Received by: Date Time <br /> f <br /> 7PRECIS 7NVIRO-TECH 2040 E.Harding Way Suite B *Stockton CA 95202*Telephone(209)462-0892*FAX:(209)462-7936 <br />