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7-11 '1 ] `-1 ) -1J J '"'7) fi) `�Tl� �° _7 1 '" '"1 ) :,l� '""1 :�`l� t�l 1 "" 11 � �]� .7-11 7—T <br /> PREE1511IN EN VORII—TEEN CHAIN OF CUSTODY <br /> ANDANALYSIS REQUEST DOCUMENT <br /> • MIAo � I P I � <br /> 1 lit <br /> Client: �1�. LO� fir" Rush Analysis: 5 Days 2 Days_24hrs <br /> (, Sampler(s): i'crC��c■r�r��r <br /> Subject to surcharge <br /> Customer Number: <br /> Comp Sampler Set Up Date: Time: QA/QC report required: yes no <br /> Address: �`� ` `1 �x Time: Mileage: If yes,To: State Client Other <br /> bo( f S, Lab number: <br /> Phone: Zbci {� <br /> FAX: 2©�j `3 c 7 Z� s A n � <br /> S <br /> SIM K z <br /> °o CV <br /> Project name: �' �'� A400-1,- C�J� ` I A - o ' <br /> R ry 1 <br /> " A <br /> Contact person: �-J fJ L a a z <br /> o �� � y <br /> 0 <br /> cu qF <br /> q q H <br /> 11 R8151 <br /> Sample Date Time <br /> Number Location Description E0 <br /> Sample Sample z ? m c9 u 4 j U <br /> f D W <br /> o <br /> 00 P <br /> Relinquished by: Dated/ ime lr'354" <br /> 3 Received by Date 1 del ime _Q - <br /> Relinquished by: Date Time Received by: Date . Time <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 />