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i <br /> PRECISION ENVIRU-TECH CHAIN OF CUSTODY <br /> AND ANALYSIS REQUEST DOCUMENT <br /> CLIENT DETAILS REPORT INFORMATION <br /> j! Rush Analysis: 5 Days _ 2 Days_24hrs <br /> Client: V, A4� l Asscc c� E 7Sampler(s):' <br /> ?'ed \_T �wTc' k <br /> Subject to surcharge <br /> Customer Number: A/ 0A QA/QC report required: yes <br /> rr�� Comp Sampler Set Up Date:— Time: no <br /> Address: V �J� Time: Mileage: If yes, To: State Client Other <br /> 11 Lab number: LE I Z I LJ <br /> i <br /> Phone: � c( - <br /> FAX: q " <br /> �� �� Y �� <br /> P, �Project name: E r .s RwCAQ <br /> Contact person: n x :° <br /> c m p _ <br /> o v c. so rS (� <br /> SAMPLE INFORMATION <br /> Sample Date Time a <br /> Number Location Description Sample Sample H Z> w u 3 75 <br /> __T_ _r__M 7-1-1 <br /> 7777 Relinquished by DateTime�� Received by: �9 d Date)?-)_141NTime <br /> Relinquished by: Date —Time—Received by: Date Time <br /> Relinquished by: Date —Time—Received by: Date Time <br /> L 7f <br /> PRECISION ENVIRO-TECH 545 E. Cleveland, Suite A* Stockton CA 95204*Telephone(209)462-0892*FAX:(209)462-7935 <br /> (:_,: -.a [:� CSE L:�.:� L...-.� ly...�i I.�� !:� 1:.,�.�, [�:, 1.:�► r . '� L�:� [..�� [::,-.::i l:�t [� C.�..�r l:�l <br />