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CHAIN OF CUSTODY <br /> PRWfSION ENVIRH-TECH <br /> AND ANALYSIS REQUEST DOCUMENT <br /> CLIENT DETAILS SAMPLING REPORT INFORMATION <br /> Rush Analysis 5 Days � 2 Days_24hrs <br /> Client LI&XV tG 1 Mit L trews) ��V_ Sampler(s) kl <br /> u C <br /> RSubject to surchargeq." '; k F-hV ,vL nlf <br /> Customer Number Comp Sampler Set Up Date — Time QA/QC report required yes no <br /> Q lient Other <br /> Address 3L {1 � �C� _. _ Time Mileage If yes, To State C <br /> 7-. d�( , CA 95ZOLA _ Lab number <br /> Phone w W <br /> FAX � - <br /> ' �° o x fit] C� 3 <br /> z <br /> Project name�r.u►►���'i' i►tea-- �.��.r k-QI�%`yti � � � �o ° � � °' <br /> C7 <br /> 2 01 <br /> E. k <br /> z O <br /> Contact person A__Ar_k �JlS tCU 4 v o a G <br /> � o _ <br /> (� y - o as 4 m <br /> 'z <br /> • INFORMATION <br /> " <br /> e <br /> SamplDate -Time ¢ a d N 1 <br /> Location Description d x 1 o <br /> Number Sample Sample a o <br /> F z'a a" C U <br /> 1fZ 91 i IMT N 5 — k X X <br /> £ m Lo 30 lz `J ti v C-1 L 41 ,�a � � _ -� \x V � <br /> `/ YhLC- I -:Z) L119 i esu C; 64T PJA S — I Ix, C <br /> J- ML, 1 - z o -z 4 `�� rrtT�.' — J k <br /> l I- G Q11.4hil I yp� -7 X X �l K - <br /> CUSTODY <br /> Relinquished by D,t, `'l'ime 1d Received by Date{ `Mime 71_0 <br /> 7777 r <br /> Relinquished by �' te Time Received b 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 /> F"' <br />