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rr1r-t-IMIUIV CIV V lKU- ILL" LriA1N Ul' UUZ!iIUllY r <br /> ANDANALYSIS REQUEST DOCUMENT <br /> ' CLIENT DETAILS )VOW REPORIANFORMATION <br /> 55 Rush Analysis: 5 Days _ 2 Days_24brs_ <br /> Client:_ AIiQ CL �n4dwr0 3 Sampler(s): <br /> Subject to surcharge <br /> Customer Number: QA/QC report required: e <br /> �! Comp Sampler Set Up Date:_Time: P v yes no <br /> Address: A� LM(LZ&J L.AI Time: Mileage: It yes, To: State _Client —Other <br /> _ <br /> 6407 95z!q-Z Lab number: l� <br /> Phone: �o20°�3 7- 701 r <br /> FAX: u .G 3 r o : -• <br /> n S gm. z q <br /> ,/� <br /> Project name: T96rm I Ff — <br /> te <br /> Contact person: DAah; lr(^ z--bl g <br /> of <br /> t3 i <br /> Sam ]e Date Time I "z o 3 - E 22� R <br /> Number Location Description Simple Sample �; E3a <br /> U <br /> CUSTODY <br /> Relinquished by: ate Time `00 Received by: Dat �+I'ime <br /> VV J <br /> Relinquished by:_ Date _Time Received by: Date Time <br /> Relinquished by: Date _Time Received by:_- Dale Time <br /> PRECISION ENVIRO•TECH 545 E. Cleveland, Suite A " Stockton CA 95204'Telephone (209) 462-0892 t FAX:(209) 462-7935 <br />