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Ulu-IN GF-CUSTDOy- <br /> PR 1510N ENVIRO-TEE" AND ANALYSIS REQUEST DOCUMENT 10c z <br /> t • ' 1 ' 1 ' 1 <br /> Client Q� Sampler(s} '�` Rush Analysis 5 Days _ 2 Days_24hrs <br /> _...�(,Lrni���,-►k �rt1�S �J1 Ulr�a�;�.� <br /> rl Subject to surcharge <br /> Customer Number QA/QC report required yes no <br /> Comp Sampler Set Up Date — Time <br /> Address. 31 DYaLt6 Time Mileage If yes, To State Client Other <br /> 9 Lab number <br /> Phone <br /> S 3 y <br /> Q <br /> FAX 9 p m a - o x -� <br /> awG z c `a <br /> Project name S'1- 1._)Q - 2 01n )`'VPrrf m a <br /> SFA w z <br /> e` P, <br /> Contact person � CL (Sr5h6n U d o <br /> � <br /> -r gF z °z W `� <br /> a <br /> a z a V <br /> w d <br /> SAMPLErn o a `C a � v1 � 1 at 11 <br /> Sample Location Descri tion Date Time o 3 3 x o <br /> Number p Sample Sample z a ? w > U <br /> MM3-0 FA *nnu Et riCL= ` C 6,1 - u X <br /> -,� T /Za �F�� (-1cwt - <br /> c X11 wCcY to 3 x <br /> 1 r 6$1 � I f-71 rnwl — 3 7C <br /> • -r kerne,, c4src`! n, I j VW 16 6) Cil ejCb , X <br /> I GL i S f�2o�c _C_a_'6_1 G LJ <br /> 777 CUSTODY <br /> Relinquished by Dat440'Pime Received by Date Mime <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 />