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i17 I <br /> PRECISION ENS![RG-�f`ECH CHAIN OF CUSTODY <br /> AND ANALYSIS REQUEST DOCUMENT <br /> 1 INFORMATIONREPORT <br /> pp Rush Analysis: 5 Days _ 2 Days_24hrs <br /> Client: <br /> l t3 Sampler(s):16 <br /> � Subject to surcharge <br /> Customer Number: Camp Sampler Set Up Date:i Time: QA/QC report required: yes no <br /> Address: Time: Mileage: If yes,To: State Client Other <br /> Lab number. <br /> Phone: x <br /> s a <br /> Lry u �p{� <br /> FAX: a w o 5 z o �' x <br /> �� w -a a <br /> Project name: s <br /> Contact person: — f { <br /> O <br /> bo � m �• do �' � <br /> '-�;AMPLE ]INFORMATION <br /> 09 333 °' l U G v <br /> Sample Date Time y a° x �^a <br /> Number Location Description Sample Sample z° FL "' <br /> 1212 <br /> v se 1 <br /> —o D 1 � <br /> CUSTODY <br /> .., . r° �•Date�Time # Received b �' '' `I-N-' Date 1 `- ` �4Time <br /> Relinquished by:1' - - -� y' t <br /> ;V <br /> Relinquished by: Date r Time Received by: Date-. Time <br /> Relinquished by: Date Time Received by: Date Time <br /> PRECISION ENVIRO-TECH 7743 N.West Lane, Suite S2 * Stockton CA 95210*Telephone(209)477-8105 *FAX: (209)477-8148 <br />