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I I I I I I I I I I I I I I I I I I I <br /> PRECISION ENVIRO-TECH CHAIN OF CUSTODY <br /> AND ANALYSIS REQUEST DOCUMENT <br /> CLIENT 1 ■ 1 INFORMATION <br /> Rush Analysis: 5 Days_ 2 Days_24hrs_ <br /> Client: Sampler(s): <br /> Subject to surcharge <br /> Customer Number: QA/QC report required: yea no <br /> Comp Sampler Set Up Date:— Time: <br /> Address: Time: Mileage: If yes, To: State —Client _ Other <br /> Lab number: <br /> Phone: x <br /> c? w m 3 x Q <br /> FAX: _ m -s <br /> s o. a x.9 z v <br /> d 4 <br /> Project name: A d v ° z <br /> � E.o <br /> 4 x m ( u <br /> Contact person: o � � � <br /> z <br /> z 333 z U.Ga <br /> SAMPLE INFORMATION <br /> Location Description SaSime '° ySam le -0 <br /> Number mplmplz> <br /> a s <br /> 11 <br /> Relinquished by: Date Time Received by: Date Time <br /> Relinquished by: Date _Time Received by: Date Time <br /> Relinquished by: Date _Time Received by: Date Time <br /> PRECISION ENVIRO-TECH 3935 N. Coronado Ave. x Stockton CA 95204 " Telephone (209)477-8105 * FAX: (209)546-7497 <br />