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771 <br /> V O E I�iIR ()` r <br /> PRECISION E AND ANALYSIS REQUEST DOCUMENT <br /> REPORTO . <br /> CLIENT DETAILS SAMPLING <br /> Rush Analysis: 5 Days _2 Days_24hrs <br /> Client:, ;'f :i. .� �f /'� '3 l>�l Sampler(s): .;'{_t. c. i, r. .. <br /> Subject to surcharge <br /> Customer Number: ,e, Comp Sampler Set Up Datef Time: QA/QC report required: yes no <br /> J tel, r 4,��✓ If yes, To: State Client Other <br /> Address: Time: Mileage: — <br /> f Lab number: <br /> J .j <br /> Phone: x <br /> 3 q (D <br /> FAX: ; - �, _ c..a �; b v o F <br /> r' � o. a w <br /> • .,� <br /> Project name. <br /> e CUB 35 Q Q u Z W <br /> Contact person: Cj �''. J <br /> z W G y,p acu <br /> F cgs J m <br /> C, <br /> Sample co <br /> SAMPLE INFORMATION i <br /> Date Time d 6 a 33 y O <br /> Number" Location DescriptlOil Sample Sample � .z>. --a-. ",c�3 <br /> 1+1 1 <br /> CUSTODY <br /> Relinquished by/f .1: ., �k Date(f.''' r Timemi ' a �e�ceivd by r ' r• i Date / ' ime <br /> err, <br /> - <br /> Relinquished by: Date Time Received by: <br /> 77 .. <br /> Date Time <br /> Relinquished by: Date Time Received by: Date Time <br /> PRECISION ENVIRO-TECH 545 E. Cleveland, Suite A* Stockton CA 95204 Telephone(209)462-0892*FAX: (209)462-7935 <br />