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----I 7_1 71 .k -� k.. l I ,♦ ��..� ., j ' <br /> PRECISION ENVI RD-TECH CHAIN OF CUSTODY <br /> AND ANALYSIS REQUEST DOCUMENT <br /> CLIENT DETAILS REPORT INFORMATION <br /> Client: r <br /> -N-A f i V I{`� l Sampler(s): Rush Analysis: 5 Days _2 Days_24hrs <br /> Subject to surcharge <br /> Customer Number: QA/QC report required: yes no <br /> Comp Sampler Set Up Dater Time: <br /> 51 z I g� If yes,To: State Client Other <br /> Address: � Time: Mileage: r <br /> �6 d �+ CA q 'j l_� - Lab number: t7 <br /> Phone: LOCI"6 <br /> FAX: 20q - 3 3 L-/ - 07 Z 3 Y m W <br /> `� ? 3 5 o <br /> m <br /> Project name: 1 " v F A e <br /> v C'S � F4'�✓ A N � \Y � � <br /> r.' <br /> Contact person: <br /> ate_ z d � b zo� <br /> SAMPLE ■ ♦ a' u <br /> U1 E R m O Qay �O <br /> TION <br /> Sample Location Description Date Time m w <br /> Number p Sample Sample 9 z'> w �q <br /> fi1Pi1] On 2 <br /> f <br /> CUSTODY <br /> Relinquished by: r- Date ime I 0 Receive by: Date *7i.e <br /> T1s/ <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 />