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turlAxn Or CU n t`O]u Y <br /> PRECISION E N V i R 0-TECH AND ANALYSIS REQUEST DOCUMENT <br /> hft: // wwty Precision lab. Com <br /> CLIENT DETAILS REPORTINFORMATION <br /> `' Rush Analysis: 5 Days — 2 Days_,-,_24hrs <br /> Client' 11 1 r{�..1!_�� � 14�;J �l 13Sampler(s)• _ L <br /> �f Subject to surcharge <br /> Customer Number: I{ 1!�� �' <br /> Comp Sampler Set Up Date:_._... Time: QA/QC report required: yes no <br /> `/. ���� ��r►'1 ���l%�. If yes,To: State Client Other <br /> Address: Time: Mileage: <br /> �J <br /> 1,'w Lab number: <br /> Phone: /16 7- <br /> J <br /> FAX: o c ' <br /> Project name: 14 J r p � `� (V l <br /> j <br /> a -e 9 o z o <br /> Contact person: o Q \ r� f `� 4 `j. w <br /> � � z <br /> Q 99 d z 3 3 3 "' 11 I lrjj t``p \ i \` U. v" <br /> �f U G as ..] Y M[ 7' \ .�� •�r�} (C <br /> SAMPLE INFORMATION <br /> I4] 1 <br /> Sample Date Time " 5a P. <br /> Number Location Description S,m ple Samplc F z <br /> 52Pl <br /> •/.•1�T1 I' <br /> 10 <br /> 1 <br /> I <br /> •F.1 Ili 11 CUSTODY <br /> Relinquished by; <br /> Date time Reccived�by: `l /s'r 2/ Date rA" Time <br /> Relinquished by: Date Time Received by: Date Time. <br /> Relinquished by: Date Time Received by: Date Time <br /> PRECISION ENVIRO-TECH 2040 E. Harding Way Suite B * Stockton CA 95202.,*Telephone(209)462-0892 * FAX:(209)462-7935 <br />