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M M M M M M M M = = = r = 10!�ddmr <br /> PRWISION ENVIR[]-TECH <br /> is CHAIN OF CUSTODY <br /> AND ANALYSIS REQUEST DOCUMENT <br /> SAMPLINGCLIENT DETAILS REPORT O . <br /> ~— Rush Analysis 5 Days ____ 2 Days_24hrs <br /> Client � � �'- [L�G(.I7 Sampler(s) �►_1t1�Y�''l-oma f�l�''!-5 l ri[`, '— <br /> La4 1j cYl Subject to surcharge <br /> Customer Number Comp Sampler Set Up Date Time QA/QC re art required y <br /> es no <br /> Address 60i-cLb <br /> Time Mileage if yes, To State C1 tent Other <br /> f) tq C , Lab number <br /> Phone <br /> U <br /> FAX Y 3 A <br /> � <br /> Project name �� )1F��I' >"E. � , <br /> ( C ��Iltit L, c. 1 �_E o <br /> 11� ✓zL <br /> Contact person �' _ v o <br /> z o $ u <br /> a m Q x W r ro Co <br /> n [� Z mb� 2 U CU <br /> tr U] <br /> r 3 3 - e a� � <br /> -11 <br /> FNumber <br /> Location Description Date Time o n° 3 3 3 x Q -� <br /> p Sample Sample F z <br /> N I't [ U: <br /> mu 1! z rz,1 ' C, NN G . <br /> � CUSTODY <br /> l ��/ <br /> RrAmquished by Date ie-4- rue rC ecelved by Date Time <br /> � C>j <br /> 777Relinquished 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 />