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PR&ISIO �1 ENVIRO-TECI-1 <br /> CHAIN OF CUSTODY <br /> AND ANALYSIS REQUEST DOCUMENT <br /> REPORTCLIENT DETAILS SAMPLING i ' i <br /> Rush Analysis 5 Days _ 2 bays____24hrs <br /> Cilient U{ +�l.�ry k L i A 0 1/u_' . Sampler(s) s � -r' <br /> V 46 1 ), � _ ;` r f Subject to surcharge <br /> Customer Number <br /> Comp Sampler Set Up Date — Time RA/RC report required yes no <br /> 1Q5 ��� �y� If yes,To State Client Other <br /> Address � LL � Time Mileage <br /> � t3C. l I �'.� �tSLC Lab number / LG" ,`��— "�� &2 <br /> Phone <br /> s <br /> 4 ~ T <br /> FAX Ep L A <br /> V N Oq'S O S <br /> �L a sd�' o z v 00 <br /> Project name Q&>t <br /> z Z <br /> Contact personJc p - r O/Dz cc <br /> R <br /> a 3 w 3 3 i `nx C/) i o Cu a' ¢moi <br /> o ;j s � A b d U :n �y I ` U 'tr <br /> SAMPLE INFORMATION -�P <br /> g O <br /> Sample Date Time <br /> Number Location Description Sample Sample F z v a j �0' U <br /> h7w (p <br /> 2. < rI 0 rte LILc 3 <br /> POO <br /> i <br /> CUSTODY <br /> RPhngmshed Date 4 �� une Received by Dat Ime7777 (� <br /> Relinquished by Date Time Received by Date Time <br /> Relinquished by Date Tune 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 />