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/4&elk k�_r_h-r #-,4 <br /> PRECISION ENVIRO-TECH CHAIN OF CUSTODY C 0f$ <br /> AND ANALYSIS REQUEST DOCUMENT <br /> REPORTCLIENT DETAILS SAMPLING <br /> Client: J <br /> C L" Je It, I'Ire P(Od II d c-k7 L_ Sampler(s): �� e Rush Analysis: 5 Days _ 2 Days_24hrs <br /> v. <br /> Subject to surcharge <br /> Customer Number: u) r /q QA/QC report required: yes no <br /> Comp Sampler Set Up Date. Tim e.. <br /> Address: 14 /2- C r L P1 K c- ' Time: Mileage: If yes, To: State Client Other <br /> �Q f,t< �(2 LI C_"i C?J Lab number: '— <br /> Phone: (.Z o G') 4 <br /> FAX: l�D�i� 941 _ -2_- q90 <br /> s_ <br /> w swbe <br /> a z <br /> o > O `- <br /> Project name: <br /> o C7 Fe u z W \ qp7 <br /> Contact person: m a z " z o ro <br /> ° a a 33a w U qe A aC <br /> z <br /> SAMPLE INFORMATION <br /> O o <br /> Sample Date Time d p a d x n <br /> Location Description o a a o <br /> Number P Sample Sample z� r <br /> J-P S�r�;,,��' & w Swart 477 <br /> 114 D10 F."I 2211A I OD <br /> .p II <br /> Relinquished by: Datey Time '/ Received by-. Date 1, l(.Time i <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 />