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v <br /> PRECISION�EII VIRE]mTECH CHAIN OF CUSTODY <br /> --,— �–_ AND ANALYSIS REQ UEST.-DOCUMENT <br /> i A ' a FORMATION, <br /> Client: Sampler(s): Rush Analysis: 5 Days _ 2 Days_24hrs <br /> Subject to surcharge <br /> Customer Number: G A Comp Sampler Set Up Date:— Time: QA/QC report required: yes no <br /> Address: Time: Mileage: If yes,To: State Client Other <br /> Lab number: _7 O Ci 3 N O / — a 1 <br /> Phone: 2 L, <br /> bD <br /> FAX' 6a m o o § <br /> b ¢ s„ 2 o z <br /> Project name: Az r <br /> v Q <br /> Contactp erson: ' a C_ F\ <br /> a z z p ` <br /> • <br /> SampleDate Time v w b <br /> Number Location Description Sample Sample � 10 a we g� E a <br /> J� M' �I UJe �� °�/r� I:r5 �' d " — <br /> a Wet <br /> .e r C,f e c <br /> +o vv. <br /> S te- <br /> REM <br /> "i s <br /> Relinquished by: Date I�f� Time__.Received by: t/i 4c) Ka Date°�Jhjj�Time <br /> Relinquished by: Date Time Received by: Date Time f <br /> Relinquished by: Date -Time-Received by: Date Time <br /> 1 <br /> PRECISION ENVIRO-TECH 7743 N.West Lane, Suite B2 *Stockton CA 95210 *Telephone(209)477-8105*FAX: (209)477-8148 �� <br />