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PRECISION ENVIRD-TECH CHMN OF CUSTODY <br /> AND ANALYSIS REQUEST DOCUMENT m <br /> DETAILSCLIENT <br /> REPORT <br /> N <br /> CD <br /> Client: p ( � ��;�e �� Rush Analysis: 5 Days _2 Days,24hrs m <br /> ampler <br /> s : -d,kt <br /> Subject to surcharge <br /> Customer Number:. F0 <br /> Comp Sampler Set Up Date:____Time: QA/QC report required: yes nu Lo <br /> Address: Time: Mileage: If yes,To: State Client Other <br /> N <br /> CS) <br /> 1 <br /> Lab number:_� :] 02, , (}3 A <br /> CT) <br /> Phone: <br /> FAX: s a M OD <br /> Q m bola _ oc o A a <br /> a ° GO � <br /> Project name: go E. Aran St <br /> ro <br /> Contact person:R R1,11 �.t '�'��. i A a 9 0 � q� <br /> z y z o <br /> as a V!z <br /> aln a Date Time °1 3 b <br /> Number Location Description �$ o a �3 x �y m <br /> Sample Sample z a m m ? <br /> LO <br /> 0 <br /> 5P- 3 <br /> ,a z <br /> u <br /> s P q C©m rte:�-� ;s5 X X <br /> s S - 5 r! 4:0 <br /> Relinquished by: Date Time Received by: Da (v 0Ze () m <br /> 3 Relinquished by: Date -Time Received by: DZ' <br /> in ib one, <br /> ate Tane <br /> Relinquished by: Data Time RCD by: Date Time <br /> PRECISION ENVIR.O-TECH 545 E. Cleveland,St. Suite A*Stockton CA 95204*Telephone(209)462-4892*FAX:(209)462-7935 <br />