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PRECISION ENVIRO-TECH CHAIN OF CUSTODY <br /> AND ANALYSIS REQUEST DOCUMENT <br /> CLIENT DETAILS REPORT INFORMATION <br /> Client: <br /> __IQGl /t C� Sampler(s): V Rush Analysis: 5 Days _2 Days_24hrs <br /> Subject to surcharge <br /> Customer Number: QA/QC report required: yes no <br /> Comp Sampler Set Up Date:— Time: <br /> If yes, To: State _Client _Other <br /> Address: Time: Mileage: _ <br /> Lab number: — @ ^°Z <br /> Phone <br /> s x <br /> )AX: ( 9L�6 ///� v A <br /> Project name:- o"f """+ '1 7/! •tH c � �2 ,� G a z <br /> s <br /> �" � � � ii a7� <br /> Contact erson: pp <br /> P m e� z Iy z <br /> m s � <br /> g� 1 <br /> SAMPLE • es 3 ro <br /> Sample Date Time <br /> m A N a <br /> Number Location Description sampl Sample Z> a a (a 1(` � v <br /> l # Al5 � s vs xV' <br /> 2 , o <br /> Relinquished by: Date Time Receivby: at Time <br /> Relinquished by: Date Time Received y:_ Date Time <br /> Relinquished by: Date —Time Received by: Date Time <br /> M PRECISION ENVIRO-TECH 545 E. Cleveland, St. Suite A*Stockton CA 95204*Telephone(209)462-0892*FAX:(209)462-7935 <br />