Laserfiche WebLink
PRECISION ENV'IRO-TECH CHAIN OF CUSTODY <br /> AND ANALYSIS REQUEST DOCUMENT <br /> CLIENT DETAILS <br /> 7Sampler <br /> ' 1 ' I 'Rush Analysis: 5 Days _ 2 Days_24hrs <br /> Client: 7(s):.-7 ompose Sampler Setup: Subject to surcharge <br /> Customer Number: Date: Time: QA/QC report required: yes no <br /> Address: <br /> Subject to Surcharge Field Sampler: If yes, To: State Client Other <br /> Time Milage: Lab number: <br /> Phone: 1UV a U a pwewewtujv"9361� <br /> S _ x <br /> FAX: a _ o s Sample Temperature: Celsus <br /> a ,� ° z <br /> sw <br /> ( )Leaking. ( )Broken. ( )VOA Headspace a>.5 N <br /> Project name: 301 <br /> � F 3 Custody Seal O yes ( > no <br /> E ? `n x • TRANSPORTATION <br /> Contact person: o m o ; <br /> EF z � � z ° <br /> R iq <br /> a <br /> zSAM <br /> b 3 v ( )Ice Chest ( )UPS ( )FedEx ( )Drop off ( )Other <br /> ' •• • E 5 a <br /> Sample Location Description Date Time o a 3 3 3 m x z ANALYSES <br /> • • AI <br /> Number Sample Sample F z> o. �c?3 63 a <br /> ' 11 <br /> Relinquished by: Date_ Time Received by: - Date Time <br /> Relinquished by: Date _Time Received by: Date Time <br /> Relinquished by: Date Time Received by: Date Time <br /> 3935 N. Coronado Ave. *Stockton CA 95204 "Telephone(209)477-8105 ` F_ X: (209) 546-7497 *Email: Peta1545@sbcglobal.net l"www.petallab.com <br />