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PREASION ENVIRO-TECH CHAIN OF CUSTODY <br /> AND ANALYSIS REQUEST DOCUMENT <br /> 1E�l LS REPORTINFORMATION <br /> Rush Analysis: 5 Days 2 Days 24hrs - <br /> Client: C<i e Sampler(s): l.f' �cy <br /> Subject to surcharge <br /> Customer Number: /()' QA/QC report required: yes no <br /> �i Comp Sampler Set Up Date:jZ Time: <br /> Address: S�U' ` �f 14 il ka Time: Mileage: if yes,To: State —Client Other <br /> Lab number:11 h- / J / �/o O <br /> Phone: <br /> FAX: <br /> °. F - o q ti <br /> 6 <br /> '� 3 w <br /> c ° z o c`Q� <br /> a x g Z <br /> Project name: " 2 F Q 0 rz <br /> R L.FQ Q II z W _� <br /> Contact person: M .2— <br /> z <br /> a <br /> x <br /> 333 _ <br /> z <br /> Sample Location Description Date SAMPLE INFORMATION <br /> Time r Z.o w 3 3 n d x a0 <br /> Number p Sample Sample F z <br /> , t 1121t 1040- C IC Ix <br /> OD <br /> Relinquished by: 0k<1 ✓ Date/,LL /tTime11 Received by: Date/ e <br /> Relinquished by: Date Time Received by: Date Time <br /> 77777 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 />