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r r I r r I r v <br /> PRECISION ENVIRO-TECH CHAIN OF CUSTODY <br /> ANDANALYSISREQUEST DOCUMMVT <br /> CLIENT DETAILS O . INFORWIATION <br /> Rush Analysis:5 Days_2 Days_24hrs <br /> Client:�A Sampler(s): �eU'� O �++ I1 A <br /> Subject to surcharge <br /> Customer Number: <br /> Cramp Sampler Set Up Date:—Time:_ QA/QC report required: yes_ no <br /> Otheres <br /> If y ,To: State_Client _ <br /> Address: Time: Mileage: <br /> Lab number: <br /> Phone: <br /> � x <br /> a a <br /> FAX: ° Sao p <br /> {{ <br /> Project name: T)ccol 1 R s <br /> Contactperson: None. <br /> a m <br /> m <br /> Ig <br /> SAMPLE INFORMATION <br /> Sample Date Time a e a <br /> Location Desexi tion o <br /> Number P Sample Sample H z> <br /> 33 W{ Rd. 610 P P - - <br /> ttle4f in a c <br /> Relingovsbed b�st�.r<— natel�Time�Raceived by: `Bata�1T'ima Iz: �,r, <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 />