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PRECISION ENVIRH-TECH CHAIN OF CUSTODY <br /> AND ANALYSIS REQUEST DOCUMENT <br /> i <br /> REPORTCLIENT DETAILS <br /> ! ' i <br /> Rush Analysis: 5 Days 2 Days 24hrs <br /> Client: Sampler(s): KiU <br /> Subject to surcharge <br /> Customer Number: QA/QC report required: yes no <br /> �� ,,�� } y�/ Comp Sampler Set Up Date:— Time: <br /> ACl{�reSS:_ InA1di1 �— rl Time: Mileage: If yes, To: State Client Other <br /> LA) U (5 Lab number: <br /> Phone: 2 1 V7 37p /_J <br /> FAX: ' ' 6 <br /> _ g w <br /> z <br /> P. <br /> l � - <br /> Project name: 51i �'l'�► ��� ���� � � d � 3 '2 4 <br /> M <br /> Q 0 <br /> Contact person: \4 U F z z a r,� V �✓ , <br /> c n <br /> SAMPLE INFORMATION <br /> o _ DC7 na +J w <br /> Sample Date Time 0. a¢ P 0 y x m 75V <br /> Number Location Description Sample Sample P Z> <br /> (f;�a { 1 L'�_-- a5 t C l ✓ ✓ ✓ <br /> Ove v <br /> CUSTODY <br /> � +61 <br /> 0 d y <br /> 0 <br /> Relinquished by: Date Time Recl ' Time <br /> l Relinquished by: Date Time Received by: -Date-Time <br /> Relinquished by: Date Time Received by: Date Time <br /> PRECISION ENVIRO-TECH 7743 N. West Lane, Suite B2 * Stockton CA 95210 *Telephone(209)477-8105 * FAX: (209)477-81.48 <br />