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I I CAAIWUF 6 u SiOD-V <br /> PRECISION E N V I R O-TECH ANDANALYSIS REQUEST DOCUMENT <br /> htl: l l www Precision Lab. Coni <br /> CLIENT DETAILS REPORT INFORMATION <br /> Client: 1�bU CG <br /> _ lrT^^c�U Sampler(s): ✓ Rush Analysis: 5 Days _ 2 Days_24hrs_ <br /> Subject to surcharge <br /> Customer Number: QA/QC report required: yes no <br /> Comp Sampler Set Up Date:— Time: <br /> Address: Time: Mileage: <br /> If yes,To: State —Client —Other <br /> Lab number: P'5'1193-0/, OA <br /> Phone: <br /> s - s <br /> A �wS �nl 9 4 <br /> Project name: Aim <br /> T " e n diCR <br /> e dg °o O lY :Vw^ <br /> Contact person: <br /> c SH (��` <br /> SAMPLE INFORMATION ' tE . " fix <br /> � d <br /> Sample Date Time <br /> NumberLocation Description Sample Sample z; a � �2 _ Jg v <br /> / h*r If Fr /-/S 3:&7f 1 1 1 1 X <br /> —QWA i 3:,ov x k x <br /> CUSTODYI L+ <br /> Relinquished by: Date Time Received b 14 Date ,/ / d me <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 96202*Telephone(209)462-0892*FAX:(209)462-7935 <br />