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PRECISION ENVIRO-TECH CHAIN OF CUSTODY <br /> ANDANALYSIS REQUEST DOCUMENT <br /> REPORTCLIENT DETAILS I • I <br /> j /fir Rush Analysis: 5 Days _ 2 Days•,�24hrs <br /> . Client: ��'�) IyC�l__ Y'��_ Sampler(s): <br /> Subject to surcharge <br /> Customer Number: QA/QC report required: yes no <br /> Comp Sampler Set Up Date:— Time: <br /> If yes,To: State Client Other <br /> Address: � S ��-- Time: Mileage: <br /> Lab number:_ 504-110 ? <br /> '?hone: <br /> s x <br /> FAX: m o o <br /> C a gw a 0 z O <br /> r b o <br /> Project name: A4 <br /> per_ o Z <br /> t e i7 F e 9 m +, � <br /> / 1/ m m x m <br /> Contact person: <br /> SAMPLE • TION CD <br /> Sample Date Time g¢ a x <br /> Number Location Description Sample Sample EF z° w r" U <br /> OD <br /> 7771 Relinquished by e fTime ecei db Date FTime <br /> Relinquished by: Date Time Received by. Date 4ime <br /> 777 Relinquished by: Date Time Received by: Date Time <br /> PRECISION ENVIRO-TECH 7743 N. West Lane, Suite B2* Stockton CA 95210 *Telephone(209)477-8105*FAX:(209)477-8148 <br /> . � [ "`"� [ I"^,:4 I`�'; f.��� 1 —"'i I,.,.. I L l I .'1 1_ Lei 'U—') Lam' L__..; <br />