Laserfiche WebLink
PRECISION ENVIRO-TECH CHAIN OF CUSTODY <br /> ANDANALYSIS REQUEST DOCUMENT <br /> CLIENT DETAILS SAMPLING REPORTINFORMATION <br /> Rush Analysis: 5 Days _ 2 Days_24hrs <br /> Nfi� D /—��/tJ�2�v,y !I r7 C� _ Sampler(s): <br /> Client: f` �" GG�tiJ [,� <br /> Subject to surcharge <br /> Customer Number: 4 -7 Z — Z Comp Sampler Set Up Date:— Time: QA/QC report required: yes no <br /> Address: 7 Z /L/ Time: Mileage: if yes, To: State Client Other <br /> ✓ f 2—r 0 Lab number: 159qc 61 <br /> Phone: Z 0<7 E Lo 7 — ; 7 0 <br /> FAX: �?J r - 3 o 0 <br /> fin!T/z.4 L <br /> Project nam ._ <br /> m 0 wy O r1+ <br /> Contact person: GL/ A-/ 74 L L� o o <br /> z <br /> xx W <br /> SAMPLE INFORMATION <br /> d <br /> Sample._. ._ Date Time d d w �, n <br /> Number LOCS1lOri DBSCrlptlall Sample Sample z Q pa �� a U <br /> b <br /> CUSTODY <br /> Relinquished by: G�"1 A/'ol"� Date Xn Time ` Received by: '+ Date 0614 Time !� <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 />