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t�fi � � � i iii iis • � CHAIN OF � • , • •• <br /> PR 15 O N E NV l R0 TECH AND ANALYSIS REQUEST DOCUMENT <br /> CLIENT DETAILS Imm I, N sa REPORTINFORMATION <br /> h Rush Analysis 5 Days ,_, 2 Days_24hrs_ <br /> Client L�4��f$hK(� 1414L3Ke�S Sampler(s) off tt�Wu $ Skad9r4 rAT <br /> �j q m q a EkV C y`C.1 M cry frL l. . ......_ Subject to surcharge <br /> Customer Number �l QA/QC report required yes no <br /> Comp Sampler Set Up Date — Time <br /> Address ._ 0 S S. El 0 O Na d 0 $i�l ft Time Mileage If yes,To ,State Client Other <br /> S fid c K f e m, CA 9,&20C Lab number — 0 0 <br /> Phone 0W BW- 14b3 € Qo <br /> s - x <br /> FAX (9Z5) 638 - <br /> wzc /ef; <br /> Ao x <br /> N <br /> �i l a <br /> Project name F A 8, a <br /> o <br /> Contact person irk R o Y d o 4A <br /> b M m Z � <br /> o d 3 SAMPLE INFORMATION r. A <br /> ° <br /> Sample Date Time d a a `� x �. F� t "7 <br /> Number Location Description Sample Sample F z' ? i:0 <br /> � a 4 tj <br /> 13 (r w ISS of 17-317 Cr ICB HP krw - 3 x Ix X <br /> Z' 66- 4S 11SS G (MT _ S - X Ix X <br /> 166- So 13o5 u IMT - _ 5 1 X x x <br /> i <br /> CUST <br /> OD <br /> ' 1M� Y1 w"v�^"V ate FG&Time 144 1 Q Fv�Nt1r4 N G K Sl <br /> le <br /> Relinquished by T ^�_____ Received by ate Time <br /> Relinquished by Date Time Received by Date 0 Mime7 • <br /> 1- <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 />