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PRECISION ENVIRO—TECH CHAIN OF CUSTODY <br /> AND ANALYSIS REQUEST DOCUMENT <br /> CLEENT 1 I REPORT INFORMATION <br /> Client: Net <br /> A_t� Amor l. Sampler(s): I-FC.�I GJc��Ili1eJ� Rush Analysis: 5 Days _ 2 Days_24hrs_ <br /> Subject to surcharge <br /> Customer Number: QA/QC report required: yes no <br /> Camp Sampler Set Up Date:— Time: <br /> Address: 90a T-v1 J I'Mal G Time: Mileage: If yes,To: State_Client _Other <br /> LAL, CA G1 Lab number: 4=1 11612- -o( <br /> Phone:-]�-` l x <br /> FAX: 3 60 CA <br /> m8 z a y a <br /> � s�:y z o ° 1! <br /> Project <br /> RR 1TJ'^ n � a <br /> Project name: f—2 IJL �1 � s _ 3 F 3 `� g C, F..k z <br /> I! A ' <br /> Contact person: � � y <br /> o v a <br /> 0 bo <br /> SAMPLE INFORMATION <br /> Q m <br /> Sampl. Date Time a g a 3 3 w° <br /> Numbe Location Description Sample Sample z'� <br /> .a2530 E. LI l'/1 9.00 c-, c,w x <br /> CUSTODY1 14010F.11141 <br /> Relinquished by Date I'A im 3. .0 Receive y: ate`Z/O ime S' VC) <br /> Relinquished by: Date Time Received by:_ Date 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 /> I _J i J _J _J _r __J A _J __J _J _J __J _J A _.A <br />