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t I- IRL•`16iU VA C1,%JV 1Rti. 1 =r i I 1 CHAIN OF CUSTODY <br /> AND ANALYSIS REQUEST DOCUMENT <br /> CLIENT DETAILS Q REPORT INFORMATION <br /> Client: 1Q� (rU /f D iR J Sampler(s): Lt1y 1 C� P V1t z Rush Analysis: 5 Days _2 Days_Mhra_ <br /> w Subject to surcharge <br /> Customer Number:—D �r <br /> (� Comp Sampler Set Up Date:_ Time:_ QA1QC report required: yes <br /> Address:— 0• � Ox Z ) g � [f es,To:State _Client. _ <br /> r ' Time: Weage: Y Other <br /> �� zJ IN �Qf fQ nel �` Lab number: - <br /> Phone: ZC� - e3 3 q K( f U. <br /> U <br /> FAX: 13 Lf � J7'7 3 <br /> Project -[9��tt{e <br /> name: e F s aW <br /> Ke 3 N m z <br /> Contact person: LbU C� m s f <br /> € z <br /> n w <br /> gF x ° + <br /> • , 's �S = S O f Inv +ran'I <br /> Sample Date Time S a S, g 'y9 <br /> Number Location Description gample Sample zQ 6 �v ¢ ,� - <br /> wd> ci _ <br /> fOaA S 11CW17,l �. l �l 2:5 ? <br /> -AIC-11 — <br /> Relinquished 6y: Dale l� I Time_+ "Aeceived bv:— _ Da / �I u¢e 3 �L <br /> Relinquished by: Date _Time Received by. Dale Tinie <br /> Relinquished bv: Date _Time Received by: pate Time <br /> PRECISION ENVIRO-TECH 7743 I\'. West Lane,Suite D2"Stockton CA 95210*Telephone(209)477-8105' FAX: (209)477-8148 <br />