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'RECISION ENVIROmTECI-1 CHAIN OF CUSTODY <br /> ANDANALYSIS REQUEST DOCUMENT <br /> DETAILS <br /> EPORrYINFORAIATION <br /> O <br /> .ent: S <br /> Spi C Rush Analysis: 5 Days 2 Days�24hrs <br /> _ m <br /> ErPS7 amer(s}: _�3 '►�-'► A)C _ _ o <br /> Subject to surcharge C? <br /> stonier Number: <br /> Comp Sampler Set Up Date:_ Time: QA/@C report required: yes no U1,c m <br /> dress:�x rL Time: Mileage: If yes,To: State Client Other <br /> 3 Lab number: L 0-1 6S Qc - (� <br /> _ 3 <br /> one: <br /> Zq+ '5Q 4y M <br /> X: - <br /> W _ W <br /> w s . LO <br /> e <br /> eject name: �P AAA: c S M <br /> iiLL person: - V:IZA f VA <br /> x m A 37 <br /> 3) <br /> SAMPLE INFORMATION I; ns M <br /> de Date Time <br /> ier Location Description 3g m <br /> Sample Sample zy a �3 , 0 <br /> n� <br /> s� <br /> to <br /> Ln <br /> Relinquished by' Datel-510 { _I_,,#!fteeeived by: Date�Tim. <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)47 7-8148 <br />