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PREC151OI�J EI'11VIRO-T CHAIN OF CUSTODY <br /> ECH AND ANALYSIS REQUEST DOCUMENT <br /> 9 hit: 11 www Precision Lab. Com <br /> 7RshAnalysie:6 Days„_2 Days_24hre_Client: Sampler(a): ✓ ubject to surcharge <br /> Customer Number: Comp Sampler Set Up Dater Time: QN/QC report required: yes no <br /> Address: Time: Mileage: if yes,To:State Client Other <br /> Lab number: PEgr93"0/i Oal <br /> a <br /> lone: <br /> e <br /> m <br /> FAX: a ., <br /> r � s � R <br /> Project name: lb54 16's <br /> Contact person: <br /> iv <br /> sample Date Time cE �� 1 <br /> Number Location Description Sample Sampled a JLC <br /> a.. / fir" If Fr -IS 3: x <br /> x x X <br /> 7777 <br /> Relinquished by: Date Time Received b . Dat."/Clime <br /> Relinquished by: Date Time Received by: Date Time <br /> Relinquished by: Date Time Received by: Date Time <br /> PRECISION ENVIRO-TECH 2040 E.Harding Way Suite B*Stockton CA 96202*Telephone(209)462-0892*FAX:(209)462-7935 <br />