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lIECISIO 1r[ ENVi.RD-TEEN CHAIN OF CUSTODY <br /> j ANDANALYSIS RE`QUESrDOCUMENT <br /> Rush Analysis:6 Days L 2 Day$_24hrs <br /> Client: _ Sampler(s): <br /> 6ubject to surcharge <br /> Customer Number: Comp Sampler Set Up Date:._..._ Time: QAIQC report required: yee no <br /> Address: Time: Aueage; If yes,To:State Client —Other` <br /> Lab number: <br /> FAX: Z Z _ a o <br /> T T BK S a` <br /> Project name: s C' g �s <br /> m C�' <br /> Contact person_ E . <br /> gig <br /> SAMPLE INFOItAIAIION <br /> ado <br /> A4 �. <br /> sample kation Dosoxiption Date Time --� <br /> Humber Sample !Sample I zOR 1? <br /> V-2 4, V <br /> Relinquished by:a -11� 11' Date Time_-_, Received '` + <br /> Date ' i �"ime�• <br /> i <br /> Relinquisbed by: Dale Time Reoeived bp: Date—Time <br /> —_Time <br /> R,eRNuished by: Date Time Received by: Date Time <br /> PRECISION ENVM0-'TECH 7743 N.West Lane,Suite S2$Stockton CA 95210*Telephone(209)477-8105*FAX:(209)477-8148 <br />