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PRECISION ENVIRII= TECH CHAIN OF CUSTODY <br /> AND ANALYSIS REQUEST DOCUMENT <br /> CLIENT DETAILS REPORTOR <br /> Rush Analysis: 5 Days _ 2 Days_24hrs <br /> 144 <br /> Client: Sampler(s): LA C <br /> Subject to surcharge <br /> Customer Number: Comp Sampler Set Up Date:— Time: QA/QC report required: yes no <br /> Address: Time: Mileage: If yes, To: State Client Other <br /> Lab number: <br /> Phone: <br /> FAX: �7 <br /> ° o <br /> R P� sem ° g z � �x <br /> Project name.V)e nrr CvF 3 v <br /> o �Fe z W aAa <br /> Contact person: CPA C <br /> . <br /> ° t <br /> s � z z <br /> R n 3�3 CO <br /> SAMPLE INFORMATION <br /> o <br /> Sample Location Description Date Time d g c a <br /> Number p Sample Sample z'° a s <br /> S�10vl <br /> 114 D10 1.11111 <br /> 1 ]� ! 1 <br /> Relinquished by:-hl U- G Datel v t Time e_ry Received by: L� E' t� �� ( 6 u _ Dat /r'-!i 7Time01 <br /> r <br /> Relinquished by: Date -Time Received by: Date.Time <br /> 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 />