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PRECISION ENVIRO-TECH CHAIN OF CUSTODY <br /> ANDANALYSISREQUEST DOCUMENT <br /> CLIENT DETAILS SAMPLING HEPORT INFORMATION <br /> r. � _ _ <br /> Client: 1-�� �� l.�xhYlknrJn,a.�'lp.�s Sampler(s):�� Rush Analysis: 5 Days 2 Days24hrs— <br /> Subject to surcharge <br /> Customer Number: <br /> n�,,// Q ` Comp Sampler Set Up Date:— Time:_ QA/QC report required: yes no <br /> Address: V37 Xfi A tY/ /`t 1t/�. Time: Mileage: If yes,To: State _Client —Other <br /> %,t,k tI2 , eIa %S 7/ S Lab number:r4: 13I 6S-- 01 -0 <br /> Phone: s <br /> 3 <br /> FAX: <br /> e q <br /> Project name: CP71 <br /> Contact person: <br /> e <br /> p a <br /> Sample SAMPLE INFORMATION Date Time a <br /> Number Location Description Sample Sample z5 p <br /> is y l� <br /> � CUSTODY <br /> Relinquished by: Date_Time Received _ Date ` alI'ime /, 2 <br /> Relinquished by: Date _Time Receive Date Time <br /> Relinquished by: Date Time.Received by: Date Time <br /> PRECISION ENVIRO-TECH 545 E.Cleveland,St.Suite A*Stockton CA 95204*Telephone(209)462-0892*FAX:(209)462-7935 <br />