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PRECISION ENVIRO-TECH CHAIN OF CUSTODY <br /> AND ANALYSIS REQUEST DOCUMENT <br /> CLIENT■ <br /> , It j .OO . <br /> MATION <br /> Client: rel c) I ytF'JI "Q�� Rush Analysis: 5 Days 2 Days_24hrs <br /> Sampler(s): � � !� `� <br /> Subject to surcharge <br /> Customer Number:_ � _ QA/QC report required: yes no <br /> Comp Sampler Set Up Date:— Time: <br /> Address: Time: Mileage: If yes,To: State _Client _Other <br /> Lab number: ';;C) Z1 12 - 0 <br /> Phone: s <br /> z 5 M A <br /> 3 <br /> FAX: Aa _(F L9-24 Z2?- . cpm o <br /> , l gw ? z m <br /> Project name: z©` t �h�y�LF� v q <br /> O 4 <br /> He <br /> H <br /> $ <br /> P <br /> .1 F <br /> Ilf/1, <br /> Contact arson: t/�\ <br /> a <br /> � <br /> a✓`. c � of <br /> Sample Date <br /> TIM <br /> Location Description SAMPLE , , <br /> umber SampNelee c Ea Aa m."'ca Vii .3 •`Jl aW a@N mrDA <br /> CUSTODY <br /> i <br /> Relinquished by ane T' _ ceived by: _ DateTime is <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 /> ,J J J J J _J rJ _.J ,J J __A .J J __J _J __-A ,J _A J <br />