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PRECISI13 i! Edi VIRD—TECH CRAW OF CUSTOD-� <br /> AND ANALYSIS REQUEST DOCUMEArT <br /> REPORTO ' <br />' CLIENT DETAILS I I <br /> mmm <br /> Rush Analysis: 5 Days _2 Da}•�_24hr� <br /> � !1/�c�iZP� Sampler(s): �A-fL��A'vDLCr <br /> Client: P I u�N Subject to surcharge <br /> Customer Number:_—D- QA�QC report required: yes no <br /> Comp Sampler Set Up Date:— Time: <br /> 1I yes,To: Stage Client _O:he.r <br /> Address: , LJ-7 IV• Gc-ul=!- + Time: Mileage: ^ n <br /> Labnumber: <br /> u t't'c /'* r. <br /> 2-►�O <br /> Phone: 3��42(4-4 3 <br /> FL1A: c rz <br /> G �x <br /> uc <br /> Project name,- <br /> 2 �' <br /> cFP ti <br /> Get o e4 , z W <br /> a4Le� _ G <br /> Contact, person: <br /> OR 'F a � 'g ' 7 0 �� y <br /> SAMPLE o " cr',t3 3 - f I 6 4' m <br /> Sample Date Time E a 3 > u; L _ U) ` U <br /> Numher Location Description Sample Sample H z P a <br /> @ it7t-f't/o® 1 : 5-s <br /> Reliuquiehed try' <br /> DatTime 2. Z� Heceived b}- <br /> Relinquished hy- <br /> Date Time Received bs•• Date `IYme <br /> LRelinquished by; <br /> Date Time Reeeived by: Date.—Time <br /> pItECISION EWIRD-TECH 7743 N.West Lane,Suite B2 4Stockton CA 95210"Telephone(20.9)477-8105 FAX:(209)477-8146 <br />