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PR ISIUN ENVIRO-TECH CHAIN OF CUSTODY <br /> AND ANALYSIS REQUEST DOCUMENT <br /> CLIENT DETAILS REPORTINFORMATION <br /> Rush Analysis 5 Days _ 2 Days_24hrs <br /> Client r k �f,., sampler7(s) F- <br /> J <br /> Subject to surcharge <br /> Customer Number QA/QC report required yes no <br /> Comp Sampler Set Up Date — Time <br /> Address 7 . El &,i- r16) 7`� Time Mileage If yes,To State Client Other <br /> Lab numberF_ 1 I I C),9 - 1 <br /> Phone G - <br /> FAX - V A <br /> c? �G3 x d <br /> a a as c z <br /> Project name ` " ti a E C] Q 1.z1 <br /> F C� <br /> z <br /> Contact person Tcl )s lshl:nio <br /> rE_ <br /> z y y d <br /> z W �+ <br /> d zSAMPLE <br /> E U w V a <br /> w v <br /> INFORMATION ' <br /> m <br /> U2 <br /> dE, <br /> Sample Date Time ¢ 3 <br /> Number Location Description Sample Sample F z y m 3 a U <br /> M3_10 6L-:> X <br /> 613 <br /> �t tf It f� 3'� �1P u1 J4 <br /> ►1,,-ice 1t <br /> 77 CUSTODY <br /> Relinquished by _ Dat Time r�=OJ Received by zK Date �fh Time <br /> Relinquished by 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*Stockton CA 95204'Telephone(209)462-0892*FAX (209)462-7935 <br />