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PRECISION ENVIRO-TECH CHAIN OF CUSTODY <br /> ANDANALYSIS REQUEST DOCUMENT <br /> CLIENT DETAILS REPORTINFORMATION <br /> Client: ��II-L-�t� I`'1�1:-h '� 1Sampler(s): (.L.l Rush Analysis: 5 Days _ 2 Days_24hrs_ <br /> Subject to surcharge <br /> Customer Number: QA/QC report required: yes_ no <br /> Comp Sampler Set Up Date:— Time: <br /> Address: PO • Bo>< 2,180 Time: Mileage: If yes,To: State Client —Other <br /> LODI C4 13' 2-41 Lab number: <br /> hone: (ZL�1) 3 34 3 <br /> Ax: (2J9) 334 - 0723 3 aim m wa <br /> m <br /> Project name: 54ZQ6e- WffL- a v <br /> s A ; <br /> Contact person: lu 1 s 4 3 w d <br /> U ZIPSAMPLE INFORMATION <br /> Ul <br /> Sample Date Time a a° U m° m C <br /> Number Location Description Sample Sample z°a 0. m a v1 N U <br /> 7-IL /z: 30 G <br /> CUSTODY <br /> / lUS <br /> Relinquished bar/ Date 7 ZZ Time Received by: DE a3 Time <br /> Relinquished by: Date Time Received by: Date 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 />