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PRECISION ENVIRO-TECH CHAIN OF CUSTODY <br /> AND ANALYSIS REQUEST DOCUMENT <br /> in I W11 0 13".111 REPORT INFORMATION <br /> Client: DLLL.UN M�/Lpfj Rush Analysis: 5 Days _ 2 Days_24hrs_ <br /> Sampler(s): /� TDY <br /> Subject to surcharge <br /> Customer Number: QA/QC report required: yes_ no <br /> Comp Sampler Set Up Date:— Time: <br /> Address: 1 b2Q LN, SU 1 TE C Time: Mileage: If yes, To: StateClieenntt _Other _ <br /> o. p,C Zl SU <br /> Lp(� i �C4pt SLC. � Lab number: W„ <br /> `w /e <br /> one: <br /> M <br /> J � x <br /> FAX: Citi 33+ - y7Z3 E3 6 u a - <br /> m <br /> � <br /> Project name: r�f+TZAKiAr.I /JA141f�r1G m a 3Fo p F <br /> Contact person: 1 Tby V a °m <br /> c <br /> F z° <br /> 4 u <br /> SAMPLE INFORMATION <br /> Sample Date Time d fi¢ 8 m o a <br /> Number Location Description Sample Sample F z°> a m 3 � a dj U <br /> JZC l _4c4Z J6 A& WELL 2 Z, , <br /> _rA45N F40m C)jnZr' rL r-yuAn <br /> W IJ�LI. C l-GAr. C4 rG{J <br /> CUSTODY <br /> Relinquished ateDate me <br /> Relinquished b e� e �- ceived by: Date Time <br /> Relinquished by: at 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 1 1 <br />