Laserfiche WebLink
t I <br /> Ri,cCt�� Ulf rAviRO-TECH CHAIN OF CUSTODY <br /> AND ANALYSIS REQUEST DOCUMENT <br /> CIAENT DETAILS IMM wale REPORT INFORMATION <br /> Client: III l urJVt` Q[� ) Sampler(s): t ��I Rush Analysis: 5 Days _ 2 Days_24hrs_ <br /> Customer Number:_Q <br /> Comp Sampler Set Up Date:— Time:_ @TSubject to surcharge <br /> QC re required; yes_ no <br /> Address: P' y• f7�x � >;U po <br /> n^ Time: Mileage: If yes, To: State _Cllent —Other <br /> _ <br /> Dt Vt S Lab number: 505 16 G I — O I <br /> PAX:334 0-7 2 3 s ads" A A i <br /> _ <br /> S o Y L 3 <br /> � 0 <br /> Project name: W� � �T- ou) � _ <br /> g q <br /> Contact person: M 11C t 1" <br /> 5: .9T r. Z 133 3 Z to <br /> ac <br /> J �Y <br /> SAi <br /> v <br /> Sample <br /> Location Description <br /> Date Time m ;> <br /> LtiD <br /> Number Sample Sample e7 z'> <br /> 12661 E. I�tigho to . (" 5116 U <br /> /L o P )w <br /> C s, <br /> Relinquished hy: Date f/6 t Timed sof Received by: Mo n y, <br /> �V.a� Date S/I[ Time 1 <br /> Relinquished by: Date —75me Received by: <br /> Date_Time <br /> Relinquished by; Date _Time Received by: <br /> Date Time <br /> PRECISION ENVIRO-TECH 7743 N. Nest Lane,Suite B2 " Stockton CA 95210 "Telephone(209)477-8105 • FAX:(209)477-8148 <br />