Laserfiche WebLink
000 ! w0 • f • • • *00000goo eewswe • eaww � I <br /> PR5ION ENVIRO-TECH CHAIN OF CUSTODY <br /> AND ANALYSIS REQUEST DOCUMENT <br /> REPORTCLIENT DETAILS SAMPLING 1 ' ! <br /> _ Rush Analysis 5 Days _ 2 Days_24hrs <br /> Client � � t` Sampler(s) t <br /> Subject to surcharge <br /> Customer Number Comp Sampler Set Up Date — Time QA/QC report required yes no <br /> Address S65 ',) fflh�o a- Time Mileage If yes,To State Client Other <br /> Lab numbercfnaw <br /> .� <br /> Phone <br /> d <br /> FAX o 3 o <br /> s-� o z <br /> lop a <br /> a n, <br /> o A d <br /> Pro ect name �(,e`��' Q lZ. " E A d <br /> y 3 c N <br /> m <br /> p �or.� fan V OD <br /> Contact person z a <br /> SAMPLE INFORMATIONo x <br /> DateSam le fiime a <br /> Location Description zNumber SampleSample 33 n m x ro <br /> ° w 3 w <br /> IAN 3? CU '�C <br /> U.3d <br /> Rwn <br /> ce. + <br /> f tl <br /> f V w <br /> Z &W <br /> _ too 6 lai -3 <br /> : CUSTODY <br /> , p <br /> Relinquished by Date!Vdime 41�Dy Received byDat Time <br /> Relinquished by Date Time Received by Date Time <br /> Relinquished by Date Time Received by Date Time <br /> PRECISION ENVIRO-TECH 545 E Cleveland, St Suite A* Stockton CA 95204*Telephone(209)462-0892*FAX (209)462-7935 <br />