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PRECISION ENVIRO-TECH �°g A,DHN`°'ANI°QUESJTDOCOIIMYT <br /> CLIENT DETAILS. SAMPLING REPORT INFORMATION <br /> /� ft ylRush Analysis: 5 Days _2 Days_24hrs <br /> Client: ICU of L, fh /1Pp t'0yi ural uti l rrw vL�L Sampler(s): 714;(L <br /> Subject to surcharge <br /> Customer Number: Comp Sampler Set Up Date:— Time:_ QA/QC report required: yes no <br /> Address: Time: Mileage: If yes,To: State _Client _Other <br /> Lab number: ASI S S-J/,01,c 7, U I/�u� <br /> "hone: <br /> FAX: amOO <br /> I a <br /> ;� <br /> a 8 A tSS s d <br /> Project name: y 5 ; o m, W F 2 <br /> x <br /> c S+ <br /> Contact person: a <br /> oo o.c$a <br /> 6 ^ <br /> SAMII'LE INFORMATION <br /> Sample Date Time o ,o %c 3 Z� /1� q u7 y <br /> Number <br /> Location""`Description Sample Sample z> d e 6, C+ /� ��.4 1 <br /> 1 1' . i3 ' 4'" 35 m1 1pip SI x <br /> W t 5 '-�T. n nAT Il S X <br /> 3 tiW C� <br /> 1 ; '9T. z n 1; . lo ) S X • <br /> c IN 's . 1. 15 :15 c - N <br /> m' ) . <br /> CUSTODY 7�;a7Z <br /> a %. ��„ ;y <br /> Relinquished by: *� " 4 . Date _ Timed:_Received by: ^� Date 9 f Time S yU <br /> lit Ga0 ri '.v / Relinquished by: Date _Time - Received by: Date Time <br /> C:.�.,. ."L ..l ♦ ill^V m �,yv <br /> - Relinquished by: .Date _Time Received by: Date Time <br /> -r- <br /> PRECISION ENVIRO-TECH 545 E. Cleyel8nd, St. Suite A*Stockton CA 95204*Telephone(209)462-0892 *FAX:(209)462-7935 <br />