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1 r I r r r- r r r r <br /> PRECISION ENVIRQ-TECH CHAIN OF CUSTODY <br /> AND ANALYSIS REQUEST DOCUMENT <br /> CLIENTPETAILS <br /> Rush Analysis: 5 Days _ 2 Days_24hrs_ <br /> Client: _ Sampler(s): +� <br /> Subject to surcharge <br /> Customer Number: <br /> Comp Sampler Set Up Date:— Time: Q.A✓@C report required: yes no <br /> Address: Time: Mileage: If yes,To: State _Client _Other <br /> Lab number: <br /> Phone: Ei <br /> FAX: a a o <br /> z <br /> Project name: <br /> m E5 <br /> a z f�7 0 <br /> Contact person: c Jx <br /> a <br /> mms" z oSAMPLE <br /> INFORMATION <br /> Sample Date _T=me a a <br /> Number Location Description Sample Sample P Z> �79 <br /> 2 7 O ,1 /l Ah Oa Z PJ 1J G, <br /> f ex Ae�'c <_ <br /> Is.; <br /> 11 <br /> : CUSTODY <br /> Relinquished by: q Datet! q Time'+_ _Received by: E7 DateTime 411 SS <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 />