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PRECISION ENVIH.❑- CCH. CITAxNT OF C���STOD1r <br /> AND ANALYSIS REQUEST DOCUiVlEIVT <br /> t REPORT INFORMATION- <br /> Chea;;: L 1 Ui.: �� J°i)U PNY y:n'o. JOEL lV1Ulw''C�P:C7 Rush Analysis: 5 Days _2 Days 24hrs <br /> —� Sampler(s): — — <br /> Pa �1 Z 80 Subject to surcharge <br /> �usvomer T?umber: <br /> Comp Sampler Set Up Date:_ Time: QA/QC report required: yes no <br /> ticidress:_ - - P= "? ti; e ,� Time: Mileage: If yes, To: State Client Other <br /> Lab number: © <br /> Phone:�Zy`�) 3 3`i -(96! 3 <br /> S3q. I2 > 3 <br /> PQA = x d , c <br /> a <br /> 'roject name: _w A o <br /> »� �� 9 <br /> Contaci; per•soz: o y . a v x � „ f •3�a ..� <br /> mF z v mi a z_ / -gym ? <br /> NOWk o 3 3 � ^Y <br /> o 3 v <br /> SAMPLE INFORMATIONE3 >r "� d� a d n v ^ t2 <br /> Sample I Date Time e C S .6 �" E o V c <br /> OJG<. iGlCrrt .��t'S� r.`.i",Yti.uir 6 4 � m x <br /> Number i Sample Sam le <br /> - - <br /> I II <br /> I <br /> I i <br /> I I � <br /> I I <br /> a I -I I I i I I II I I <br /> g <br /> --- I Relinquished by. r U Date Z' ime .� received by: i' <br /> Date 9�2 Time <br /> (DD -- Relinquished by: Date Time ReceivedCn by: Date Time <br /> Relinquished aa•: Date Time Received b <br /> Y' Date Time <br /> rr /V( <br /> t:':F .1Ei`VI'.I.:V-I.`.EC:I:I. 7743 N.Test Lane, Suite B2 x Stockton CA 95210 W Telephone(209)477_8105*FAX:(209)477-8148 <br />