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T <br /> CHAIN OF C TODY <br /> PR 15111N ENV 1 RD-TECH ANDANALYSIS REQUEST DOCUMENT <br /> CLIENT DETAILS SAMPLING REPORT INFORMATION <br /> Rush Analysis 5 Days _2 Days_24hrs <br /> Client C0 i`fl V n t`a Igg 0 Li`l 5 Sampler(s) 10 4a, 5 h+i da wA TAT <br /> I`17 q%'x�q i, 0kv tE��4 �� q Subject to surcharge <br /> Customer Number — QA/QC report required yes no <br /> Comp Sampler Set Up Date Time <br /> Address 1105 S• U P c gad p Sart et _- Time Mileage If yes,To State Client Other <br /> �toc�to CA .95 20 6 Lab number Q> � <br /> Phone (92-6 ) 9 IT 6 3. �y <br /> FAXC5 i <br /> Project name <br /> Contact person F x y W y b z zgy <br /> a 4 <br /> ez <br /> s � <br /> SAMPLE INFORMATION <br /> Sample Location Descri doll Date Time . �o a 3 3 uz v <br /> Number p Sample Sample F Z> <br /> 101;100 Z20 [r 11411 - S - x x x <br /> 61 0 930 ( IMT — -- 5 — x X x <br /> G IMT - - S - x Ix x <br /> �-f B1- W 9a0 3V <br /> GG Ke Gw — 3 x x <br /> B'+ -4S 930 % tMT `" S - x x X <br /> 13-+ - 90 955 G IMT — S x Ix x <br /> Cab--a 11 s� Cr [MT - — S - x x x <br /> Quo- 30 <br /> 1-105 Cr f NT I S - x X x <br /> X36- 5f 1VO G 1M; - 5 - x X X EL:f__ <br /> 7777CUSTODY <br /> Relinquished by Date [�S Time 14 15 Received by 1 b � {�,�$ t����� ��Date � e <br /> Relinquished by Date Time Received by at Aime <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 />