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PRECISION ENVIRO-TECH CHAIN OF 4bUSTODY <br /> ANDANALYSIS REQUEST DOCUMENT <br /> CLIENT DETAILS I REPORTINFORMATION <br /> n I(Qvry MO-4h Rush Analysis: 5 Days _ 2 Days_24hrs_ <br /> Client: /////d�A / /''►ctr�b v Sampler(s): " <br /> --T ����,' Subject to surcharge <br /> Customer Number: M Comp Sampler Set Up Date:7�Time: ,3! QA/QC report required: yes no <br /> Address: g <br /> 2 3 3 5-0 Al lackTOii t K oa4( Time: l ZMilea e �'2 y If yes,To: State —Client —Other <br /> / Lab number: <br /> Phone: /-20f - 33Y - 0 dI. <br /> 3 - 7z = m <br /> FAX: I- 2 09 - S 9 e s Z <br /> 2335` N T a o <br /> Project name:- <br /> E50 aGl{yOA e %oQGt7 s = e <br /> U .4 <br /> $ o <br /> v 2zi <br /> Contact person: 7—Ov <br /> O C`� <br /> SAMPLE • / 3"<i <br /> Sample ja <br /> Location Description io a B <br /> C <br /> Number Sample Sample <br /> vAi <br /> a <br /> base 6;6 A,*r wex <br /> 7 �A i 1 . Received by: 0.— Dat Z 1 gime O-tr <br /> Relinquished by:&y;A1 MB7"Rh Date-Time <br /> Relinquished by: Date _Time Received by: Date_ Time <br /> 77Relinquished 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 />