Laserfiche WebLink
PRECISION ENVIRO-TECH <br />Client: i 2 N a� ��4iy !: t i�?L� I I Sampler (s): <br />Customer Number: C -T L CCS <br />Address: <br />CHAIN OF CUSTODY <br />AND ANALYSIS REQUEST DOCUMENT <br />Comp Sampler Set Up Date: Time: <br />Time: <br />Mileage: <br />Rush Analysis: 5 Days _ 2 Days 24hrs <br />Subject to surcharge <br />QA/QC report required: yes no <br />If yes, To: State —Client 7 Other <br />Lab number: � 781 / — 0/ <br />• OD <br />Relinquished by: Date Time Received by: Date gime ViL <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 />Phone: <br />s <br />_ <br />d <br />x <br />m <br />Y <br />= <br />FAX: <br />" <br />_ <br />m <br />o <br />o <br />d <br />z <br />7p <br />° <br />A333S� <br />Fa�3 <br />o <br />C!1 <br />w <br />y . <br />name: <br />aProject <br />0_Fe <br />z <br />Contact person: <br />o <br />a.z <br />z <br />z <br />z <br />3a0 <br />b/3i <br />SAMPLE INFORMATION <br />Location Description <br />DSample ate <br />ime <br />o <br />Number <br />Sample <br />Sample <br />q <br />• OD <br />Relinquished by: Date Time Received by: Date gime ViL <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 />