Laserfiche WebLink
PRE+C;ISION ENVII{,O -TECH URA1N OF UUSTODY <br /> ANDANALYSIS REQUEST DOCUMENT <br /> DETAILSCLIENT REPORTO . <br /> S <br /> U� , Sampler(s): �Ak <br /> 5 G i1 4 � R� S L h S , C ti *.Yd ) Rush Analysis: 5 Days _2 Days_24hrs <br /> Client: _ <br /> Composite Sampler Setup: Subject to surcharge <br /> Customer Number: 5 S Cr Date: <br /> Time: QA/QC report required: yes no <br /> Address: 35-5Z W y05, /:M 17 o!5 .4 VE Subject to Surcharge Field Sampler: If yes,To: State —Client 7J`'ir'oe �Set=, �T5730 Other <br /> ,C <br /> Time Mdage: Lab number: o O LA (Q O yt' O <br /> A <br /> Phone: 269- .5_fY — 045- SAMPLE CONDITION <br /> g <br /> a <br /> Sample Temperature: Celsus <br /> FAX: 2 0°� S c1 fi - Q4; 5 I o P P <br /> B c Cv Pl�✓sCY" CMA C;_ –g a z ()Leaking.( )Broken. ( )VOA Headspace <br /> Aga M <br /> Project name: Custody Seal ()yes ( )no <br /> 5:�.k1.sCh�zhtl@rutien•co� � � � ��E 9 `� � <br /> s o TRANSPORTATION person: . ' <br /> z s5 z o <br /> g z a a 4cehest ()UPS ()Fed Ex '�Drop off ( )Other <br /> INFORMATIONSAMPLE m yds <br /> Sample Date Time o a a �' 3 $ z° , <br /> p Location Description 0 3 3 e 1 <br /> Number P Sample Sample z> w yc? a <br /> I k i ✓hie,. hae e4' '� / it )2:�T �� P } <br /> CUSTODY <br /> r Relinquished byDat 4 MI)Time Received by: Date ,''�4ims 1 • 30 <br /> Relinquished by: Date _Time Received by: Data Time <br /> U� Relinquished by: Date Time Received by: Date Time <br /> 3935 N.Coronado Ave.*Stockton CA 95204*Telephone(209)477-8105*FAX: (209)546-7497*Email:Petal545@sbcglobal.net*www.petallab.com <br />