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ftC.'� + s <br /> PRECISION ENVIRO-TECH CHAIN OF CUSTODY � f <br /> AND ANALYSIS REQUEST DOCUMENT <br /> CLIENT DETAILS A REPORT INFORMATIONf <br /> Client: L)� n ee P _ Sampler(s): V1 1/ , 1 _7 <br /> Rush Analysis: 5 Days _ 2 Days_24hrs <br /> s + LU r d vC.Ys <br /> C p Subject to surcharge <br /> Customer Number: J L�� l �— -- QA/QC report required: yes no <br /> Comp Sampler Set Up Date:_ Time: <br /> Address: / 4 L- PI ha I Time: Mileage: If yes, To: State` Client Other <br /> e,k �—o�-, C!2, (1- �� Lab number: l Q ,"\ q Q � <br /> Phone: <br /> s <br /> FAX: �Z09) <br /> a Bmi z $ <br /> Project name: �� - 0�� �� W F A o s <br /> Z F e <br /> q o <br /> Contact person: o m <br /> g z ' z z0z W a `° a <br /> 0 4o m <br /> E z a S a SAMPLE INFORMATION C/I E- <br /> CU t/1 <br /> w m y:, <br /> cc <br /> Sample Date Time <br /> Location Description 3 <br /> NumberSample Sample Z' ° �? m w � a U <br /> �- the.t-oll I -o Pr f3 , ,3 4-7-11 11:457 6- P NP <br /> • 7 CUSTODY <br /> 4-7-11 <br /> Relinquished by: Date Time '• C Received by: Date -(I Time 12 <br /> Relinquished by: Date Time � Received by: Date Time <br /> Relinquished by: Date Time Received by: Date Time <br /> PRECISION ENVIRO-TECH 3935 N. Coronado Ave. * Stockton CA 95204* Telephone(209)477-8105 *FAX: (209)546-7497 <br />