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PRECISION ENVIRO-TECH CHAIN OF CUSTODY <br /> ANDANALYSIS REQUEST DOCUMENT <br /> CLIENTDETAILS REPORTINFORMATION <br /> ss � d Rush Analysis: 5 Days _2 Days_24hrs_ <br /> Client: IVf I I 6 //�1 I jyI � ,� �J.1. L� Sampler(s): C 1w Ha,�Lff <br /> Subject to surcharge <br /> Customer Number: QA/QC report required: yes_ no <br /> ' � 1 Comp Sampler Set Up Date:— Time: <br /> Address: -LIn( S}yI ' al Vv Time: Mileage: If yes, To: State _Client _Other <br /> lol A 15Z4C Lab number: <br /> Phone: S(07 — l x <br /> FAX: — ,3(n9— `tZZg <br /> ��— w d^ m o o <br /> Project name: 1 5 r�� s _ 3FA 75 F " <br /> 0Contactperson: oo w� <br /> _!swQx'"gi <br /> SAMPLE <br /> ' • / 1111111C <br /> Sam 1, Date Time <br /> IOCatOri Description Sample Sz o <br /> m� <br /> U <br /> l_.1 DLO <br /> CUSTODY <br /> Relinquished by Date TimeJS..L+Z Receive h ate �dTime 2S <br /> Relinquished by: Date _Time Received by: Date Time <br /> Relinquished by: Date _Time Received by: Date Time <br /> PRECISION ENVIRO-TECH 545 E. Cleveland, Suite A* Stockton CA 95204*Telephone(209)462-0892 * FAX:(209)462-7935 <br /> J J —J —J —A _J J _ A J J .J --A _J J —J —J --_J -_J J <br />