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PRECISION ENVIRO-TECH CHAIN OF CUSTODY <br /> AND ANALYSIS REQUEST DOCUMENT <br /> CLIENT DETAILS REI'OI?T INFORMATION <br /> Rush Analysis: 5 Days _ 2 Days_24hrs <br /> Client: �71 ( (On -�7 /�Lf'�'�wt� Sampler(s): <br /> Subject to surcharge <br /> Customer Number: QA/QC report required: yes_ no <br /> Comp Sampler Set Up Date:— Time: <br /> Address: & gJ Int Time: Mileage: If yes,To: State Client —Other <br /> I-A-eL-. St,; Lab number: )�12L I S CS I <br /> Phone:_ <br /> FAX:- f Z0� 1 3 3 i-( - a-t Z 3 3 A <br /> c v � Z <br /> Project name: <br /> 0. <br /> Contact person: lel; k"_ /0 u g Z s 3 s z W G <br /> 3 U e py o.Gv � <br /> m a v v A <br /> SAMPLE • = d o <br /> Sample Date Time d g¢ 4 �, m N Q m <br /> Location Description <br /> Number Sample Sample <br /> dt o f IF <br /> CUSTODY <br /> • ,' <br /> Relinquished by: �k Date 5/' Time 2-100 Received Date lfime 1, 0( <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 />