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PRECISION ENVIRO-TECH r CHAIN OF CUSTODY r r <br /> AND ANALYSIS REQUEST DOCUMENT <br /> REPORTCLIENT DETAILS *U.10 I U 111 PC <br /> �1 ^ c�,V I 'D t A ff j 4 Rush Analysis: 5 Days _2 Days_24hrs <br /> Client: :,E I L 0. A O L)F a6O O Sampler(s): YV V� <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: ::��/--dZ <br /> Phone: <br /> S _ x <br /> FAX: <br /> a m=s - A <br /> v R 3 0 W 3 <br /> a 'Cm O 4 Com, <br /> ywa ZO N <br /> Project name: v SFA yy ° a ; <br /> s � _ 3w3 N K! F � -• <br /> Contact person:,PAU lO u)C LC H__ = <br /> O <br /> 6: 4 <br /> i 3�3 <br /> INFORMATIONSAMPLE <br /> Sample Location Description Date Time <br /> Number p Sample Sample Et' <br /> I k �� cup G F te 6w <br /> TMAX--F CA YA? LINtON <br /> 3 - W VE1Z <br /> LOGE- <br /> CUSTODY <br /> Relinquished by: i� Datem- Kime�Receiv y: ateW- arfine ��' SS <br /> Relinquished by: Date _Time Received by: Date Time <br /> Relinquished by: Date _Time Received by: Date Time <br /> PRECISION ENVIRO•TECH 545 E. Cleveland, Suite A* Stockton CA 95204*Telephone(209)462-0892* FAX:(209)462-7935 <br />