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PREEISION ENVIRO—TECH CHAIN OF CUSTODY <br /> XVDANALYSIS REQUEST DOCUMENT <br /> CLIENT REPORT INFORMATION <br /> DETAILS <br /> f/� �1� �' V2 O'b 1 l Rush Analysis:5 Days _ 2 Days_24hrs <br /> Cient: 1 V D/f Sampler{s): U <br /> Subject to surcharge <br /> CUStDmer Number: Comp Sampler Set Up Date:—Time:_ Q��C report required: yes— no <br /> Address: Time: Mileage: If yes,To: State_Client _Other <br /> Lab number: <br /> Phone: x <br /> s � V <br /> 3 8 A m <br /> FAX 36 - GZz � a g z ax <br /> Project name• To�c.o1 , H3a_ v n.l N v f� <br /> . <br /> 03 <br /> _u 'zd <br /> Contact person: _ a°' <br /> z six z o <br /> 9 �3 z 3� y O7 ao <br /> SAMPLE <br /> • , o 3 <br /> SampleDate Time o � a° <br /> Number Location Description Sample Sample 9 Z> 6 m8?s <br /> 11/2, <br /> MIN <br /> Relinquished 6y: lY�j Date • Time �2 Received by: - t�l t:n?'..� Data-11,�j Ake <br /> Relinquished by: Date Time Received by: Date—Time <br /> Time <br /> ttelinquished 1, Date _Time Received by: Date Time <br /> PRECISION ENVIRO-TECH 7743 N.`Vest Lane,Suite B2* Stockton CA 95210*Telephone(209)477-8105 FAX:(209)477.8148 <br />