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P @V15111N ENV1RII= TECH CHAIN OF CUSTODY <br /> ANDANALYSIS REQUESTDOCUMENT <br /> a BN N Lu <br /> Client G l7Sarmnpler ��.r�j�0� Rush Analysis 5 Days 2 I)ayss <br /> Subject to surcharge <br /> Customer Number <br /> �f l Comp Sampler Set Up Date — Time QA/QC report required yes- 7 n <br /> Address S�d C��f�I� If yes, To State Client <br /> Time Mileage —Other <br /> Lab number aG A 0 — Q 1" <br /> Phone <br /> U <br /> R <br /> FAXw � ��3 _ �, .. Q w <br /> 0 O 5 <br /> Project name o <br /> Contact person rt L I u 00o <br /> ~• <br /> o d z 3 3 3 x o Goa q) <br /> s v R -3 a <br /> A g <br /> Sample Date Time <br /> Location Description <br /> Number Sample Sample F z a 0 U <br /> �n l <br /> Sr ll <br /> Joe I <br /> •.r <br /> _ G <br /> 77777Re�hnquishedby� <br /> linquished by Da� 3e •110 Received by Dat dime <br /> Date Time Received by Date Time <br /> Relinquished by Date Time Received by Date Time <br /> PRECISION ENVIRO-TECH 545 E Cleveland, St Suite A W Stockton CA 95204*Telephone(209)462-0892 FAX (209)462-7935 <br />