Laserfiche WebLink
Y Y l l w Y Y Y I 1 1 1 1 1 1 Y 1 <br /> PRECISION ENVIRO-TECH CHAIN OF CUSTODY <br /> ANDANALYSIS REQUEST DOCUMENT <br /> CLIENT Y� 1 • • INFORMATION <br /> Client: L J L FII N 4 MIS E- P H Y Sampler(s): H L x::x CIOZ-4-A Rush Analysis: 5 Days _ 2 Days_24hrs <br /> Subject to surcharge <br /> Customer Number: (209) 9 9(o — 53-73 QA/QC report required: yes no <br /> Comp Sampler Set Up Date:— Time: <br /> Address: 19,2 C K] k E i TLEAAN 4/Y- Time: Mileage: If yes, To: State Client Other <br /> 4t,Tr- & c.c,,Ql, CA `/S24 ( Lab number: �O� Z6J2 -O � <br /> Phone:(-2(;9) 33 1 — 60 'Z x <br /> s = <br /> FAX: (2_09) 331E — 0 3 2 3 m g o r [A, <br /> Z' v x <br /> Project name: 1_ kc_ lc M A N <br /> Contact person: AL E x CULL A a 0 <br /> F <br /> a e9 a 33S z W 3 o bi G m <br /> 4 z d93 N v U Gv <br /> SAMPLE INFORMATION <br /> Sample Date Time <br /> Number Location Description Sample Sample F z° 5 � <br /> o(,7N EAST PZfpCo-At- <br /> 114 <br /> zG O <br /> CUSTODY <br /> Relinquished h K Date lQGw TimehReceived by: T . DateTime .S Y , <br /> Relinquished b Date Time Received by: Date Time <br /> Relinquished by: Date Time Received by: Date Time <br /> PRECISION ENVIRO-TECH 7743 N. West Lane, Suite B2 *Stockton CA 95210*Telephone(209)477-8105 * FAX: (209)477-8148 <br />