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PRECISION ENVII�O-TEtH 1 ZHA& O� UUAI'OD� <br /> AND ANALYSIS REQUEST DOCUMENT <br /> le REPORTINFORMATION <br /> PJ 01O q�tn.r� C, Rush Analysis: 5 Days _2 Days_24hrs <br /> Client: ��i ( rcb�I'-y�R���� Sampler(s): t-- off <br /> Subject to surcharge <br /> Customer Number: N0ok QA/QC report required: yes no <br /> Comp Sampler Set Up Date:— Time: <br /> �y v Zv�y`c„�yl p �b :,� If yes,To: State Client _Other <br /> Address: _ �J �{ Q � Time: Mileage: CLI <br /> L,— i [A f''Sz q D Lab number: CLI 2112 Q <br /> Phone: _ 7-77 0 t x <br /> FAX: M; <br /> Project name: T s o sr F ;-2y s _ _ �� z �i o <br /> e m 9' h S o D+ <br /> Contact person: <br /> z 5"5;y 9 z o W Q � W ro <br /> mm <br /> c ? 33g V ��i r1�` y. U�.a'�� cc <br /> SAMPLE ' 4 'F < t � � <br /> Sam leDate Time e a w <br /> Number Location Description sample Sample X> w E91 <br /> l z 1 Ll(o I K-C'4fw w,_a _ t- - y 7 l q -'s G P P D w — — <br /> CUSTODY <br /> Relinquished by: a Zr'-ime ��L Received by: ate Time 16 <br /> Relinquished by: Date _Time Received by: Date 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 />