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PRECISION ENV1ROwTECH CHAIN OF CUSTODY <br /> NOR ANDANALYSIS REQUEST DOCUMENT <br /> MMWW 0 REPORT INFORMATION <br /> Client' I Sampler(t): Rush Analysis:5 Days _2 Days__24hrs_ <br /> Customer Number:_ Subject bsurcharge <br /> Address: Comp Sampler Set Up Date:—Time:_ QAIQC report required: yet_ no <br /> Time: Mileage, If yes,To: Slate_Client —Other <br /> Phone: <br /> Lab number: ��� l I X�el C�� �• <br /> � <br /> a ! <br /> FAX: lit a <br /> a # <br /> IM a 4 <br /> Project name: f aq.. o a 8 Q <br /> Contact person: ° � 9 Wim ` z <br /> a z 3 0l 7ip8 <br /> 3i3 6 c <br /> Semple a y <br /> Number Location I)esarfption Date Time t° �3r, y� � � +4 <br /> Semple Samp]e �.` z ne p �I` s :9 <br /> Relinquished by-pff7aAwl, Date jj��`, R <br /> Time eceived by. <br /> Da me <br /> Relinquished b <br /> Relinquished by: Date <br /> -T Received by: Date Time <br /> y. Date __ <br /> PRECISION ENVIRO-TECH 545 E.Cleveland,St.Suite A• Stockton CA 95204'Telephone(29 462.0892'FAX:(209)462-7935'me <br />