Laserfiche WebLink
PRECISION ENVIRO-TECH CHAIN OF CUSTODY <br /> ANDANALYSIS REQUEST DOCUMENT <br /> MATION <br /> Client: bik'("''� ` A&V Sampler(s): M'f Rush Analysis: 5 Daye, _ 2 Days_24hrs_ <br /> Composite Sampler Setup: Subject to surcharge <br /> Customer Number: RM Date: f (7lJ Time: 11' V QA/QC report required: yes_ no <br /> Address: P. 0 . �K y) V,.) Subject to Surcharge Field Sampler: If yes,To: State _Client Other <br /> C-1 q.� / Time Mdage: Lab number: _!i0S (�'O3 — O1 <br /> Phone: C�9) �3 /"GG/3 0SAMPLE (10NDrriON <br /> x <br /> FAX: (L�y ) 3yy - 07Z � � �a _ � Sample Temperature: Celsus <br /> 9mO � t <br /> Leaking.O Broken. ( )VOA Headspace <br /> Project name: Custody Seal( )yes ()no <br /> Contact person: 94'i�e 7-Oy <br /> 5 <br /> a z m<a A7Iee Chest ()UPS ( )Fed Ex Drop off ( )Other <br /> e1' 2 3 5 <br /> SampleANAL REQUFs,rED <br /> Number <br /> 1-7 Date Time g®i <br /> Location Description sample Sample i> a m2 L. m <br /> E,r+�I Ro.a `e u�r< �n'�3 iI �' v X x <br /> Relinquished by: Date 5 i 7'�Time Received l Date`51 'lime <br /> Relinquished by: Date _Time Received by: Date Time <br /> Relinquished by, Date Time Received by: Date Time <br /> 3935 N.Coronado Ave. *Stockton CA 95204"Telephone(209)477-8105*FAX:(209)5467497*Email:Petal545@sbcglobal.net*www,petallab.com <br />