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PRECISION ENVIRO-TECH CHAIN OF CUSTODY <br /> ANDANALYSISREQUEST DOCUMENTCLIENT DETAILS <br /> ti <br /> REPORT INFORxAnoN <br /> N <br /> Rush Analysis:5 Days_2 Days_24hra_ m <br /> Client: 6OWC.f D RAQL Cpgj Gl Sampler(e): J2CCE Ly�Q <br /> t\ Subject to surcharge <br /> mm <br /> Custoer Ntmmber: Y1 C Comp Sampler Set Up Date:_ Time:_ q i m <br /> QA/QC report cared:re yes na <br /> Address: �SO �L '�T�tf�C ve Time:� Mileage: IF yes, To: State_Client _Ocher(7GlCTf7N Ci4 X15206 //�� -^� 0 0 y <br /> Lab number: L1 T V v ! L0 <br /> Phone: Z O Q - 2 3 �l - �- Q d <br /> s Be z <br /> Be <br /> v r� t r A A <br /> FAX: (, 19 i� 1 �L-�} } & a 37y <br /> n sa-3 o z ti <br /> Project name:_ IPA Vim} i L a �_�a r� <br /> s o m <br /> s �la a °� l�' <br /> Contact person: �2 LZ �� <br /> QA aa3 8 a a <br /> AMPLE INFORWIATIONti <br /> Sample Date Tlme ' g@< a 8, 'c <br /> Number Location Description Sam le Sample z'> '6o m S qj U H <br /> 'k-M sko 1,,.7+ N ILL q AM P f WWI lxlxlXX o <br /> z <br /> m <br /> z <br /> WHOM i <br /> H <br /> A <br /> L7 <br /> —I <br /> m <br /> n <br /> x <br /> `_� 7 Relinquished 47 � Date / i TIIIIT925 Receive a/ ,'/Ti-- <br /> Relinquished <br /> , <br /> y: . ' Dat,_7 rTimem <br /> Relinquished try: Date _Time Received iy: Date Time m <br /> N <br /> Relinquished Ly: Date _Time Received by: Date Time <br /> m <br /> PRECISION ENVIRO-TECH 3435 N.Coronado Ave.s Stockton CA 96204"Telephone(209)477-9105*FAX:(209)546-7497 <br />