Laserfiche WebLink
PRECISION ENVIRO-TECH CHAIN OF CUSTODY <br /> AND ANALYSIS REQUEST DOCUMENT <br /> CLIENT 1ETAIL$ REPORT INFORMATION <br /> Client: o Sampler(s): <br /> Rush Analysis: 5 Days _ 2 Days_24hrs <br /> �� <br /> Subject to surcharge <br /> Customer Number: Comp Sampler Set Up Date:— Time: QA1QC report required: yes_ no <br /> Address: Time: Mileage: If yes,To: State _Client _Other <br /> Lab number: 5011113 – G I <br /> Phone: ?(e j <br /> � � x <br /> FAX: <br /> �qi m <br /> ° <br /> Project name: 0Jv .7� 'v�.� 2 <br /> Contact person: <br /> SAMPLE „oy a <br /> Sample Date Time <br /> Number <br /> Location Description o <br /> Sample Sample � z'> a /m�.c+� � � Y r��•�O U <br /> �CZZ X12'0 <br /> W011J.110 <br /> `\ <br /> Relinquished by: ,6- Dat.VLZ—Time 0 Received by:�, Date-i-122105LTime <br /> Relinquished by: Date _Time Received by: Date.Time <br /> Time <br /> Relinquished by: Date Time Received by: Date Time <br /> PRECISION ENVIRO-TECH 7743 N. West Lane, Suite B2*Stockton CA 95210 *Telephone(209)477-8105 *FAX:(209)477-8148 <br />