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PRECISION ENVIRH-TECH <br /> CHAIN OF CUSTODY <br /> AND ANALYSIS REQUEST DOCUMENT <br /> REPORTCLIENT DETAILS SAMPLING INFORMATION <br /> C11erit: G Rush Analysis: 5 Days <br /> 772 Days�24hrs <br /> Sampler(s): — <br /> Subject to surcharge <br /> Customer Number: <br /> Comp Sampler Set Up Date: Time: QA/QC report required: yes no <br /> Address: Time: Mileage: If yes, To: State Client Other <br /> Lab number: <br /> Phone: <br /> FAX:-' 4 r <br /> Project name: �� _E- <br /> -t <br /> m x <br /> �.e <br /> Contact person: ; e Q o <br /> o °H z <br /> I cd <br /> m <br /> SAMPLE INFORMATION <br /> CII <br /> ampIe Date TimeLocation DescriptionNumberSample' Sample <br /> s w 3 w <br /> p <br /> : CUST <br /> o <br /> y <br /> OD <br /> Relinquished by:52. ;j IC) I;i:'1: Date Time Received by: Date Time <br /> Relinquished by: Date Time Received by: Date . Time <br /> 7777 Relinquished by: Date Time Received by: Date Time <br /> PRECISION ENVIRO-TECH 7743 N. West Lane, Suite 132 * Stockton CA 95210 *Telephone(209)477-$105*FAX: (209)477-$I4$ <br />