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PREE1510N ENVIRD-TECH CHAIN OF CUSTODY <br /> ANDANALYSIS REQUEST DOCUMENT <br /> CLIENT DETAILS SAMPLING REPORT INFORMATION <br /> -�--�a � ' � #����= 17" Rush Analysis: 5 Days _2 Days^24hrs�„ <br /> Client: Sampler(s): <br /> Subject to surcharge <br /> Customer Number: QA/QC report required: yes no <br /> Comp Sampler Set Up Date:— Time: <br /> Address: P` Time: Mileage: <br /> If yes,To: State Client Other <br /> wo y { 2-41 1 <br /> Lab number: <br /> Phone: (2ol) 33g-&(a[3 <br /> x <br /> AX: <br /> r ;7.9) <br /> bo <br /> z o `r <br /> Sc pc�a Gc�A � V <br /> Project name: <br /> Contact person: A4 7 o V m m <br /> W a�i <br /> SAMPLE INFORMATION <br /> 0. <br /> ��}f1 4h� <br /> Sample Date Time R E¢ a 6i v`1 x ,Q yV, <br /> Number Location Description Sample Sample P z'° a 3 a " U <br /> 't. <br /> 777 � � <br /> RelinquishedDate /I�91Pime �' f`� Received by: f'�— %j r�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. * Stockton CA 95204 * Telephone(209)477-8105* FAX: (209)546-7497 <br /> L ? L._.-i L...-.-1 L-1 L_ L. t L__i L.._`_' L-1 L-__) L.._' L... 1 --._' L__,.1 L__f L.w..� E_-. <br />