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PRECISION ENVIRO-TECH CHAIN OF CUSTODY <br /> AND ANALYSIS REQUEST DOCUMENT <br /> CLIENT DETAILS REPORT INFORMATION <br /> Client:_ pler(s): . <br /> Rush Analysis: 5 Days _2 Days_24hrs <br /> i�'r ��" Sam � ��-, <br /> Subject to surcharge <br /> Customer Number: <br /> Comp Sampler Set Up Date:— Time: QA/QC report required: yes_ no <br /> Address: Time: Mileage: If yes,To: State Client _Other <br /> Lab number: <br /> hone: <br /> � � x <br /> 3m <br /> FAX: U � ;�3 S o �Aj � <br /> Project name: <br /> s <br /> a SFA <br /> s � Ly �' <br /> Contact person: d 9 0 3 T9 <br /> '^ e99 46r <br /> W dJ SAMPLE INFORMATION <br /> w ° a <br /> Sample a <br /> Date Time gggga <br /> Number Location Description Sample sample z a m q r�V tj <br /> r <br /> F <br /> CUSTODY <br /> Relinquished by: %. Date Time Received by:- ' -eL /' / Dat ime <br /> i <br /> Relinquished by: Date _Time Received by: 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 /> i <br />