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CHAIN OF CUSTODY <br /> PRECISION ENVIRO-TECH <br /> AND ANALYSIS REQUEST DOCUMF,NT r: <br /> 1 ' 1 1 <br /> (1, ` 1 • 1UY f�l i, "_.1 -7Zyt Rush Analysis: 6 Days _ 2 Days_24hrs_ <br /> Client: j� '" �' Sampler(s): <br /> Subject to surcharge <br /> Ctlstotller Number: --- Comp Sampler Set Up Date:_ Time:_ QA/QC report required: yes_ no _ <br /> Address: ( J Time: Mileage: If yes,To: State —Client —Other <br /> a <br /> _ _ � � •- � i' Lab number: <br /> Phone: <br /> S = x <br /> FAX: 1 ) J (>7 1 a ;;a - o <br /> o w a m o o z (p a x <br /> Project name: <br /> Contact person: r7 <br /> e <br /> rSAMPLE INVORMATION <br /> a a <br /> Sam le Date Time a m�3 i*• 6SC 'g <br /> Location Description Sample <br /> gyp v <br /> Number Sample Sam le z> _ <br /> Ul l 1. J.77 I': 3„ i _ ll`r,l <br /> t <br /> k. <br /> ti <br /> Relinquished by:•' ,e- 4 Date_Time Received by: ' Datel . I 'Time_rj <br /> Relinquished by: Date _Time Received by: Date Time ! <br /> Relinquished by: Date Time Received by: Date Time �._. <br /> I' <br /> PRECISION ENVIRO-TECH 7743 N. West Lane, Suite B2' ;tockton CA 95210 *Telephone(209)477-8105 * FAX:(209)477-8148 <br />