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--- - - -- - r ,� �■ r �■r r� �r r r r r �r <br /> "PNEWSfhTNMFr0-TECH CHAIN OF CUSTODY <br /> i AND AN <br /> , ALYSIS REQUEST DOCUMENT <br /> CLIENT DETAILS SAMPLING INFORMATION <br /> Rush Analysis 5 Days _2 Days_24hrs <br /> Client GL f Samplle-r(s} !_� � <br /> Subject to surcharge <br /> Customer Number <br /> } Comp Sampler Set Up Date — Time QA/QC report required yes no <br /> Address ?At' b(Y COO �. TimeMilea a If yes, To State Chent /Other <br /> �� {� _ g Lab number ! <br /> ' )One <br /> � 3 d M <br /> � _ � m <br /> FAX' <br /> o 3 <br /> a aVF ° v z <br /> Project name. Q � �, <br /> z onq 5 A v 'If <br /> Contact person (nu CCAZ5) W m <br /> ts7 � V <br /> SAMPLE INFORMATION <br /> m c a w <br /> Sample Date Time <br /> Number Location Description Sample Sample E :'R a m-t 4 v v� <br /> mc�l 11 S.-C, tib C,w Ix x <br /> rnwz- fit '' "C M ; <br /> AX XX - <br /> : CUSTODY <br /> a <br /> 7RehnqLushed <br /> by Date�Time l F cewed � f� Dat e i� <br /> ? b l Date Time Received by . L , / Date Tune <br /> by Date -Time-Received by Date Tune <br /> PRECISION ENVIRO-TECH 7743 N West Lane, Suite B2* Stockton CA 95210 *Telephone(209)477-8105 *FAX (209)477-8148 <br />