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PRECISION ENVIRII=TEEH CHAIN OF CUSTODY <br /> AND ANALYSIS REQUEST DOCUMENT <br /> r MR 1 ' <br /> Rush Analysis: 5 Days _ 2 Days�24hrs <br /> Client <br /> l k7 l V i Sampler(s) <br /> Subject to surcharge <br /> Customer Number: <br /> Comp Sampler Set Up Date:— Time: QA/QC report required: yes no <br /> ' If yes, To: State Client Other <br /> Address: F `' "` k ----- --'-- Time: Mileage: <br /> Lab number: <br /> Phone: <br /> FAX: o <br /> a.,�•. _, c� �'=3 -. x <br /> b o <br /> S ° o ❑ R� <br /> Project name: 9 i _: ­ <br /> ��^ e <br /> a <br /> Contact person: r <br /> 3 3 z c R o <br /> e 41 <br /> 11 KU U9 CV <br /> Sample Date Time a 8¢ a m r5 m <br /> Location ocation Description Sample Sample P <br /> ' rim11 <br /> Relinquished by' <br /> �'• Date Time 4' Received b ' <br /> q y: - --D ate' Time <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 />