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CHAIN OF CUSTODY <br /> PREEISION ENVIRO-TEEH AND ANALYSIS REQUEST DOCUMENT <br /> hit: 11 www Precision Lob. Com ' <br /> CLIENT DETAILS REPORT INFOMLMON <br /> Rush Analysis: 6 Days_2 Days T24hra_ <br /> Client: $ampler(a): 1ACM - Nq✓Y -A/ <br /> Subject to surcharge <br /> Customer Number: QArQC report required: yea no <br /> Comp Sampler Set Up Dater Time: <br /> Address: Time. Mileage: If yes,To:State Client —Other <br /> Lab number: <br /> Phone: - <br /> FAX: a <br /> Project name:, 1861 1Dok,_% w. Kms^ <br /> Contact person:SAMPLE JNF0JtAJA'l1f()N <br /> z I a <br /> as °' <br /> sample Date Time <br /> Number Location Description Sample Sample � fl a <br /> 1 ' -e Lin e. 1 t•Z t 0300 er MT Imp IS <br /> F en ff 05b5r 1, imr NV <br /> e"n # � 1 o3to mr P ►� <br /> 0 <br /> H MAI <br /> Relinquished by: Date Time Received by. Date e <br /> m67 0or <br /> Relinquished by: Date Time Received by: Date Time <br /> N� Relinquished by: Date Time Received by: Date Time <br /> �� PRECISION ENVIRO-TECH 2040 E.Harding Way Suite B*Stockton CA 95202*Telephone(209)462-0892*FAX:(209)462-7935 <br />