Laserfiche WebLink
PRECISION ENVIRO-TECH CHAIN OF CUSTODY <br />AND ANALYSIS REQUEST DOCUMENT <br />Client: l k\U v% a �Jt v vQirw� <br />Customer Number: <br />Address: <br />Phone: <br />FAX:�E}A{LTvc1.-� 171�wsJR*�t-WRPtt�-{. CdM <br />Project name: AgC <br />Contact person: `'��1_ ! kkbR=-NtJ <br />._ ♦ . 7 • • <br />Sample Location Description Date Time <br />Number p Sample I Sampli <br />iw�.a� �aotatk t�f c>F Wit.. Ott Srjw[Zt lz: � <br />Sampler <br />Composite Sampler Setup: <br />Date: Time: <br />Subject to Surcharge Field Sampler: <br />Time Milage: <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 Other <br />Lab number: lU 7, 2 (' f _'� —n <br />Sample Temperature: Celsus <br />() Leaking. () Broken. ( ) VOA Headspace <br />Custody Seal () yes () no <br />( )Ice Chest ()LIPS ( )Fed Ex ( )Drop off ( )Other <br />CUSTODY <br />Relinquished by'Tt�t&Tt!4 b�R.:t 06 Date �W Time 1' Received <br />77Y Date%1. JTime 12-' <br />L <br />Relinquished by: Date Time Received by: Date Time <br />I <br />Relinquished by: Date Time Received by: Date Time <br />Page <br />3935 N. Coronado Ave. * Stockton CA 95204 * Telephone (209) 477.8105 * FAX: (209) 546-7497 * Email: ihvlPRnatallah rnm * umrw natnilah -- <br />s <br />(max <br />"^ <br />s` <br />z <br />o <br />y <br />a <br />-EG <br />0 <br />Z <br />z <br />C <br />WF <br />mm <br />z <br />yam <br />o <br />- <br />O <br />� <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 Other <br />Lab number: lU 7, 2 (' f _'� —n <br />Sample Temperature: Celsus <br />() Leaking. () Broken. ( ) VOA Headspace <br />Custody Seal () yes () no <br />( )Ice Chest ()LIPS ( )Fed Ex ( )Drop off ( )Other <br />CUSTODY <br />Relinquished by'Tt�t&Tt!4 b�R.:t 06 Date �W Time 1' Received <br />77Y Date%1. JTime 12-' <br />L <br />Relinquished by: Date Time Received by: Date Time <br />I <br />Relinquished by: Date Time Received by: Date Time <br />Page <br />3935 N. Coronado Ave. * Stockton CA 95204 * Telephone (209) 477.8105 * FAX: (209) 546-7497 * Email: ihvlPRnatallah rnm * umrw natnilah -- <br />