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PRECISION ENVIRO-TECH CHAIN OF CUSTODY <br /> AND ANALYSIS REQUEST DOCUMENT <br /> CLIENT I IINFORMATION <br /> Rush Analysis: 5 Days\_ 2 Day. 2,l hrs_ <br /> Client: I�1� lonl ��1K-PNY Sampler(s): MIIL6 -7-01 Rush <br /> Subject to surcharge <br /> Customer Number: <br /> Comp Sampler Set Up Date:— Time:_ QA/QC report required: yes no <br /> Address: �' 0 ' �� 21 Pio Time: Mileage: If yes, To: State Client Other <br /> Loo CA 4q 5 Z4 Z- Lab number: <br /> hone: <br /> z <br /> FAX: Cay ) 33�- 0 7 23 v t �0 <br /> O � r <br /> zx <br /> CGi <br /> Project nameC?U/J s 3 F a s S <br /> t3 z <br /> 5 arA q' z ri cn <br /> Contact person: <br /> �� a 333 9.g CA <br /> SAMPLE <br /> . I I o_' C3E d Los a _ ? <br /> o <br /> SampleDate Time m' z —E z <br /> Q <br /> L0 <br /> LSample Sample Number p p zcation Description ° a c 3 d <br /> F > <br /> 114 DIVA V.1'EJ <br /> CUSTODY <br /> I <br /> Relinquished 772777� Date 3_31•Time y�'AReceived b ` - t ime <br /> Relinquished by: Date Time Received by: ate 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 /> 1 1 1 J I I / J _J 1 1 1 J 1 1 1 J J <br />