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PRECISION ENVIREI=TECH CHAIN OF CUSTODY <br /> AND ANALYSIS REQUEST DOCUMENT <br /> PO . INFORMATION <br /> /� <br /> 7Sampler(s): _Cc'�"� {•/� uC.Cf I " e � Rush Analysis: 5 Days _ 2 Days_24hrs <br /> Client: � orL <br /> Subject to surcharge <br /> Customer Number: QA/QC report required: yes no <br /> Comp Samplex Set Up Date:— Time: <br /> Address: Time: Mileage: If yes,To: State Client Other <br /> Lab number: <br /> Phone: <br /> _ x <br /> G 5 <br /> FAX: <br /> 3 o z o Go <br /> �x <br /> Project name: <br /> N <br /> Q z W a <br /> Contact person: �`lT <br /> a F, z = z o w `� al a <br /> ti /� <br /> ~ v <br /> c U mdaySAMPLE INFORMATION w a v 1 ai <br /> Sample Date Time d Q a 3 ,� <br /> Number Location Description Sample Sample z° 3 63 w <br /> Z_ <br /> 7777.'010 CUSTODY <br /> Relinquished by: to Time �Q Receive ate ime , <br /> Relinquished by: Date Time Received by: Date <br /> 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 /> L�y mil L C.� J LL'.'a' LL`I L._.J L :: L_-) L t:.= ! L�! L--' L____J C_� LZ�_; L�[ L�] L.,. Zt <br />