Laserfiche WebLink
PRECISION ENVIRO-TECH CHAIN of CUSTODY <br /> AND ANALYSIS REQUEST DOCUMENT <br /> DETAIILS REPORT INFORMATION <br /> Client: A a- SW c ems{ C e�'ny 1 V 6l1>71 a6 I J C A 1 Rush Analysis: 5 Days_2 Days_24hrs_ <br /> (pler(s): Y 1 V!>11 I �Q'�/1 <br /> (' Composite Sampler Setup:. <br /> Subject to surcharge - <br /> Customer Number: `�� Date:. ,.Time:. QA/QC report required: yes— no <br /> Address: S`'10."v go a, Subject to Surcharge Field Sampler: If yes,To: State_Client _Other <br /> -A � S 2( S Time Milage: . Lab number: U 0 SO log - <br /> o ., <br /> Phone: 20 - 14C-An. -i 041Z = 01 Ila W0L9L4Jh"qF1J 1tv <br /> FAX: `Lo 01 �{ 6� - 1 m .9 ea o Sample Temperature: Celsus <br /> a M 8qc _Zc <br /> Leaking.O Broken.( )VOA Aeadspace <br /> Project name: ' m Custody Seal()yes ()no <br /> Contact person: Dtr 11 Ll I e 8 m e <br /> )Ice Chest ()UPS ()Fed Ex ()Drop off ()Other <br /> SAMPLE 11�TFORNIATION <br /> a $ <br /> Sam le Date Time ca w° m° ' z <br /> P <br /> Location Descri tion �o <br /> Number p Sample sample � z> & �n� g a = ANALYSES � �� � <br /> W, JAt 9 — - 11GO Pub Lit, 096 Co CR ,) <br /> 2 - VIA- - h <br /> Relinquished by Dates. Time Z�I S0 teceived by Dateiwwftne-,1. <br /> �,, <br /> Relinquished by: - 9" - Date Alh.. n',R.ewived by: 401 Datel Time <br /> Relinquished by: Date:_Time .Received bp. Date Time <br /> 3935 N. Coronado Ave. * Stockton CA 95204 * Telephone (209) 477-5105 * FAX: (209) 546-7497 * Email: jhvle@petallab.com * www.petallab.conl <br />