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PRECISION ENVIRO-TECH AND ANAALYSISOREQES�TDOCOUMENT <br /> h11: 1/ www Precision Lab. Cam <br /> CLIENT DETAILS V11 <br /> REPORT INFORMATION <br /> � I I� _ / I ! <br /> Rush Analysis: 5 Days — 2 Days_24hrs <br /> Client: � l,�l I�+..� �✓ t � "�r ;�f tG Sampler(s): La�� rte,i <br /> Subject to surcharge <br /> Customer Number: 06 7' <br /> �^ Comp Sampler Set Up Date: Time: QA/QC re ort required: yes <br /> no <br /> ' A/. If yea,To: State —Client —Other <br /> Address. Time: Mileage: <br /> /J% �� �7,•7� �/} 'J.1 7 CJ r Lab number: <br /> Phone: J4 r� 7- I Kt'.r <br /> FAX' _ /�� /1�r 1 9 3 - 7d <br /> Q <br /> 73 <br /> z wtipProject name: .9 fte <br /> e°t- g re <br /> 7i� <br /> Contact person'SAMPLE INFORMATION ' <br /> Sample Date TimeLocation Description oBt <br /> z Number S mple Sample 0 y <br /> Z. G tAf x K <br /> S p/ <br /> CUSTODY0 11 <br /> JL <br /> Relinquished by: Date Time Receivedj`hy: _ i — Date "- Time _ •-_C' - <br /> Relinquished by: Date Time Received I Date Time <br /> Relinquished by: Date Time Received by: Date Time <br /> PRECISION ENVIRO-TECH 2040 G. Ilarding Way Suite B * Stockton CA 95202 *Telephone(209)462-0892 * FAX: (209)462-7935 <br />