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PRECISION ENVIRD-TECH CHAJN 0J_ G(JSr1:'0DY <br /> AND ANALYSIS REQUEST DOCIMMIENT <br /> CLIENT 1 REPORT1 <br /> Client: Sampler(s): J' e j Mon 1fno Rush Analysis: 5 Days _2 Days_24hrs_ <br /> _ <br /> Customer !+\lumber: P go x 2 I �0Subject i:o surcharge <br /> Comp Sampler Set Up Date:_ Time:. QA/QC report required: yes no <br /> Address: 2' �1 `awl X SNL ,_ Time: Mileage:. if yes,To: State + Client ___Other <br /> Ct � � Lab number: 1 �I r-4 �—61 <br /> Phone: (Z rj9) <br /> FAX: m� m � - <br /> m z <br /> Z �— L, , 2 ( vas �q ! w N <br /> Project name: 3 I I I o £F Q o o M ^ 1 <br /> � h <br /> Contact person: 'Kf "o`f 1 oo v I ^,� <br /> v J ! <br /> a` a G j ' <br /> SAMPLE INFORMATION <br /> �! <br /> Sample Date Time <br /> Number EEOC �.1;i.oi1. .Descript:ion ;c <br /> Sample Sample I z> <br /> ! I <br /> 1 ! I <br /> Fovcej <br /> I 1 <br /> . t <br /> Relin uish `r'14L _ I S O1 t,/�' i <br /> cQ I q ed by: Date Time Received by: ate l N jl'tTne�_:_5- I <br /> cn <br /> Relinquished b3'= Date Time Received by: Date-Time _ <br /> oi Relinquished by: Date Time Received by: Date Time <br /> cn <br /> E?:C;E;C.E:S7:0i1T R,0-'V.ECJE 7743 N.West Lane, Suite B2*Stockton CA 95210*Telephone(209)477-8105*FAX:(209)477-8148 <br />