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PRECISION ENVIRO-TECH DHAINIOQcuUESTDOODYT <br />REPORTCLIENT DETAILS SAMPLING INFORMATION <br />Rush Analysis: 5 Days _ 2 Days_24hrs <br />Client:/ �� Sampler (s): <br />Subject to surcharge <br />Customer Number: CAZOU <br />Comp Sampler Set Up Date:— Time: <br />QA/QC report required: yes <br />no <br />If yes, To: State Client Other <br />Address: <br />Time: <br />Mileage: <br />Z' <br />Lab number:F <br />Phone: <br />5 <br />FAX: — <br />m <br />a <br />a <br />ArQ <br />o <br />o <br />0 <br />z <br />o <br />x <br />Project name: <br />y <br />�; <br />3 <br />v Fe <br />N <br />z <br />WoContact <br />Ic3i, <br />person:/.s�ivr <br />d= <br />o <br />m°m <br />i"`� <br />z <br />! mo <br />•�.�] <br />SAMPLE•mO <br />w <br />ami <br />^� 2 '�I"it9�3z <br />Date <br />Location Description <br />Time d <br />g d <br />a <br />w <br />v, <br />Gi <br />F <br />x <br />�I <br />`�Sample GQ <br />z 7Number <br />Sample <br />Sample <br />z' <br />�" <br />(JiIl aYGa— <br />'", <br />P <br />'v <br />k <br />x <br />13 Did•!CUSTODY <br />Relinquished by: Date Time Received by: Date`e d Time df - <br />Relinquished by: Date Time Received by: Date Time <br />Relinquished by: Date Time Received by: Date Time <br />PRECISION ENVIRO-TECH 545 E. Cleveland, St. Suite A * Stockton CA 95204 * Telephone (209) 462-0892 * FAX: (209) 462-7935 <br />