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r r r I I r i I <br /> PRECISION ENVIRO-TECH CHAIN OF CUSTODY <br /> ANDANALYSIS REQUEST DOCUMENT <br /> CLIENT DETAILS REPORT INFORMATION <br /> Rush Analysis: 5 Days _2 Days_24hrs_ <br /> Client: - -. ti Sampler(s): <br /> Subject to surcharge <br /> Customer Number: <br /> Comp Sampler Set Up Date:— Time: RA/QC report required: yes no <br /> Address: Time: Mileage: If yes,To: State _Client _Other <br /> Lab number: <br /> Phone: <br /> FAX: <br /> k _yw o z 5 Fl v x <br /> Project name: <br /> Contact person: gg g o a w^ <br /> SAM <br /> ATI <br /> • <br /> • • <br /> Sample Date Time a <br /> Location Descriptiono �a o <br /> Number Sample Sample zz> at! <br /> W <br /> I Ei <br /> Relinquished by: -'�yY ate Time Received by: Date Time <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 />