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iil � ��l � lil ! ! 00 *H*NOFG��4DYqp� � IW-Ww:!W-W- <br /> PR SION ENVIRB-TECH ANDANALYSISREQUEST DOCUMENT <br /> CLIENT DETAILS SAMPLING REPORT INFORMATION <br /> Rush Analysis 5 Days 2 Days_24hrs <br /> Client 5 � Sampler(s) <br /> Subject to surcharge <br /> Customer Number Comp Sampler Set Up Date — Time QA/QC report required yes no <br /> Address 1 f ''-4`to Time ]Mileage If yes,To State p�—Client Other <br /> Lab number ^ C`r 70-0 <br /> Phone 17 x <br /> FAX L�2� 1 Z <br /> Cq <br /> Project name <br /> �`► L -- �y �'yf z <br /> o c? d o a z W S1fvv O tb o <br /> Contact person <br /> m U� d y <br /> SAMPLE INFORMATION <br /> En <br /> w �_Date ime Sample zNumber Location Description Sample Sample j p <br /> U <br /> a G 6- I <br /> Z 1uIx 3. <br /> CUSTODY <br /> Relinquished by Date AL-t-- Time Received by e Tine <br /> Relinquished by Date Time Received by <br /> Time <br /> 7777 <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 />