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PRECISION ENVIRO-TECH CHAIN OF CUSTODY <br /> AND ANALYSIS REQUEST DOCUMENT <br /> CLIENT DETAILS 01 17 REPORTINFORMATION <br /> { � 7 A Rush Analysis: 5 Days _2 Days_24hrs <br /> Client: { f I I ) �.�'�fl �� ��' Sampler(s): <br /> Subject to surcharge <br /> Customer Number: QA/QC report required: yes_ no <br /> �.` Comp Sampler Set Up Date:— Time: <br /> rli'IC' y I If yes,To: State._Client —Other <br /> _ <br /> Address: q�7 r�� It , {� I � Time: Mileage: I p� <br /> ! �/qp��� CA <br /> 35, 4-C Lab number: <br /> Phone: 1 �IU — . l5 2507 -5-7(11 1/ n/1 1 v <br /> FAX:_ 7( ` — r�� — 2zga m o 0q v <br /> �R3 x <br /> w gW <br /> Project name: iiff CC <br /> S. �. v, <br /> Contact person: d ~' _ 0 <br /> a a3Y viZ WGO <br /> o mq N <br /> SAMPLEE5 G <br /> q = <br /> • • W F£ '�' c,�'x o <br /> Sample Date Time <br /> Descripti <br /> Numher Locationon Sample Sample nn9 z° +� �io3 m a 'd GO U <br /> 7 U Qc3C lZ DLI) <br /> CUSTODYViol <br /> Relinquished by Date Time Receive b ate �dTime �' �'*� <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 1 J _J -J J (_ 1 J J .J .J J J J —1 _l _A —J J <br />