Laserfiche WebLink
I l I l I 1 I I 1 1 I 1 I I 1 I I I I <br /> PRECISION ENV1R0-TECH CHAIN OF CUSTODY <br /> AND ANALYSIS REQUEST DOCUMENT <br /> CLIENT 1 ' 1 ' 1 ' INFORMATION <br /> Rush Analysis: 5 Days _ 2 Days_24hrs_ <br /> Client: Sampler(s): <br /> Subject to surcharge <br /> Comp Sampler Set Up Date:— Time: <br /> Customer Number: QA/QC report required: yes no <br /> Address: Time: Mileage: <br /> If yes,To: State Client Other _ <br /> Lab number: <br /> Phone: <br /> s - x <br /> FAX: o s <br /> o q 3 <br /> o z o' t�' <br /> n v C4 m .J <br /> Project name: m 9 y s <br /> N W � <br /> S, s —te o z W O� <br /> Contact person: a � _ 4 z c� <br /> zrQ <br /> G � 4 <br /> om <br /> ?aw v] <br /> SAMPLE INFORMATIONs d B= Yui `> `3 rtiv V:i' `" >, <br /> Sample Date —rime <br /> Location Description o 0 0 `o <br /> Number Sample Sample i> a' > U <br /> El— <br /> � 1 <br /> Relinquished by: Date Time Received by: Date Time <br /> Relinquished by: _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 />