Laserfiche WebLink
PRECISION ENVIRO-TECH CHAIN OF CUSTODY <br /> ANDANALYSIS REQUEST DOCUMENT <br /> CLIENT DETAILSI 1 ' INFORMATION <br /> /} �I 'n �r In n <br /> Cllent: ��l I I V,�UI Jl �l/� i)��� , ��]l��,I�I�Y.� Sampler(s): Rush Analysis: 5 Days _ `L Days_L4hrs <br /> Subject to surcharge <br /> Customer Number: 7 QA/QC report required: yes— no <br /> �� � � r� Comp Sampler Set Up Date:— Time:_ <br /> Address: 167 l od aftioa��{�Lday Time: Mileage: If yes, To: State _Client _Other _ <br /> C�Y 15 ;7* I Labnumber: 5C1L� 2Sl$ ) <br /> Phone: 2 ��� — d��` �7� x <br /> S s q <br /> FAX: 20GI — �fn�I 4f; m m o o s <br /> , <br /> 611 Projectname: A (l � V1� gte <br /> Contact person: of Z $zs <br /> SAMPLE INFORMATION A tit <br /> Sample <br /> LOCHtlOri Description m� <br /> Number Sample 6 <br /> Oct 23250 Spw �eS t 2S i•o0 _ _ <br /> ! CUSTODY <br /> Relinquished by: O J1'ime Z• ,© Received by: / .' Date �%�.' ime , <br /> Relinquished by: Date _Time Received by: Date Time <br /> Relinquished by: Date Time Received by: Date Time <br /> PRECISION TECH 545 E. Cleveland,Suite e A* S Stockton C j 95204 Telephone e(209 462-0892 FAX:,209)4627935 <br /> __JI_ J - JJj � , , ._J <br />