Laserfiche WebLink
PRECISION ENVIR O- TECH CHMN OF CUSTODY <br /> AND ANALYSIS REQUEST DOCUMENT <br /> REPORT • , <br /> =mom" <br /> Cfienc: 11�XL-LC)}3 .t- i_kOPA_i P Sampler(s): Rush Analysis:is: 5 Days _2 Days_24hrs_ <br /> Composite Sampler Setup: Subject to surcharge <br /> Customer Number: Composite <br /> Time: QA/QC report required: yes no <br /> Add cess:� �Y,,1 Subject to Surcharge Field Sampler: If yes, To: State Client Other <br /> t� 7 le !� r�r Time Milage: G 1�,O�Oq <br /> � Lab number: _e <br /> .1?11orle:_ Z4 e ! <br /> Y <br /> x �� <br /> � 3 <br /> 1+t1X: � d Sample Temperature: <br /> d tr o o y Celsus <br /> � �� � � v m () Leaking. ()Broken. ( )VOA Headspace <br /> Project name: _ <br /> k 3 ° Q Custody Seal <br /> j w3 _ � � Y ()yes no <br /> S mFA N <br /> Tom}, a m `.3 .. q 2 <br /> !if"• s w x . . • . . . <br /> �ontace person: '�' [�J}• }�.rd J�}�r � �� � o <br /> i s ()Tce Chest ()UPS ()Fed Ex ()Drop off ( )Other <br /> •Vo I <br /> ■ <br /> Sample Date Time v A ° <br /> Number I-oc�itiirn .Desc:ripti.on a a � m x z <br /> Sample Sample F z;>o c • 1, <br /> Relinquished by: Bate ime_�' Ived by: ate`� 1 70 J- <br /> r(D - Relinquished by: Date Time Received b I <br /> � y� — Date Time <br /> o Relinquished by: Date Time Received by: Date_ Time <br /> v <br /> 935 N. Coronado Ave. * Stockton CA 95204 * Telephone (209) 477-8105 * FAX: (209) 54(3_7,97 * V-0. <br />