Laserfiche WebLink
PRECISION ENVIRO-TECH CHAIN OF CUSTODY <br /> AND ANALYSIS REQUEST DOCUMENT <br /> REPORTCLIENT DETAILS O ' <br /> r i Rush Analysis: 5 Days _2 Days_24hrs <br /> Client: D lk WN Lie-CH� Sampler(s): E <br /> Subject to surcharge <br /> Customer Number: <br /> Comp Sampler Set Up Date:— Time: QA/QC report required: yea no <br /> v <br /> Address: �' ° ' <br /> Time: Mileage: If yes, To: State Client Other <br /> LO'),' CJ - OK Z-4 1 Lab number: <br /> Phone: 3 <br /> FAX: ? , dqj <br /> Fi <br /> Z 00 <br /> Project name: STA <br /> Contact person: 0 <br /> �a �- <br /> en ❑E. z Z R <br /> CD <br /> SAMPLE INFORMATION <br /> Sample Date Time a ¢ a x <br /> Number Location Description}o �j Sample Sample F z° a � w U <br /> x 'Clx 4 1 gscJrJ�Y7 N t4wl ee l�-21 12:/V P 1)1"\/. <br /> r <br /> Ic <br /> CUSTODY <br /> -2 T' P''7�O Receiedb t�-- � Aate T e <br /> Relinquished by: _ Date ime y_ <br /> 777 ' <br /> Relinquished by: Date Time Received by:- Date Time <br /> Relinquished by: Date Time Received by: Date Time <br /> PRECISION ENVIRO-TECH 3935 N. Coronado Ave. " Stockton CA 95204* Telephone(209)477-8105*FAX: (209)546-7497 <br /> L._ L-2 Lo-2 L__. L___) L__1 L—) L—1 L__ ? L__) f,___! L._.._J L___, L-2_ _2 t_. L._. E � <br />