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PRECISION ENVIRO-TECH CHAIN OF CUSTODY <br /> ANDANALYSIS REQUEST DOCUMENT <br /> CLIENT DETIVILS It m <br /> / 1 <br /> a Rush Analysis:5 Days_ 2 Days_24hrs <br /> Client: lawe�/�EO N✓ Sampler(s): <br /> Subject to surcharge <br /> Customer Number: ' EQ <br /> Comp Sampler Sat Up Date:— Time;_ QA/QC report required: yes_ no , <br /> Address: Time: Mileage: If yes, To: State _Client Other <br /> Lab number; I of y <br /> & Phone: _ s <br /> w FAX: aa <br /> Na Project name: �I <br /> ti <br /> a. Contact person:_ <br /> F z Oil <br /> Asa 0. ° <br /> SAMPLE INFORMATION <br /> Sam Ie Date Time 11®�� <br /> Number Location Description Sample Sample 1 11 a r�gV m .?_ L24� t? <br /> / -5.4 <br /> M <br /> m <br /> CP <br /> r <br /> N <br /> a <br /> m <br /> m <br /> N <br /> a <br /> u� <br /> c+i <br /> N <br /> m <br /> tmv Relinquisbed by: DaLjR 41'5_Ramived b Da �e <br /> m <br /> N Relinquished by: Date _Time Received byr Date Time <br /> CD <br /> CD <br /> Relinquished by: Date _Time Received by: Date Time <br /> PRECISION ENVIRO-TECH 545 E.Cleveland,St.Suite A e Stockton CA 95204 4 Telephone(209)462-0892 z FAX: (209)482-7935 <br />